Modified adeno-associated virus vectors and delivery thereof into the central nervous system

ABSTRACT

The present invention relates to modified adeno-associated virus (AAV) vectors for use in transducing a cell in the central nervous system (CNS) of a subject, and for use in the prevention or treatment of a CNS disease. In particular, the modified AAV vectors according to the present invention comprise at least one surface-bound saccharide, and are to be administered directly to the CNS but not intracerebroventricularly.

FIELD OF INVENTION

The present invention relates to modified adeno-associated virus (AAV)vectors for use in transducing a cell in the central nervous system(CNS) of a subject, and for use in the prevention or treatment of a CNSdisease. In particular, the modified AAV vectors according to thepresent invention comprise at least one surface-bound saccharide, andare to be administered directly to the CNS, but notintracerebroventricularly.

BACKGROUND OF INVENTION

Diseases affecting the central nervous system (CNS) have beenparticularly difficult to treat with traditional drugs, among otherthings because of low blood-brain barrier penetration abilities and highoff-target effects.

The advent of gene therapy offers the potential for transformativetherapies to slow down or stop disease progression in late-stagepatients, and to prevent the appearance of clinical symptoms inearly-stage, asymptomatic individuals (Lykken et al., 2018. J NeurodevDisord. 10(1):16).

Multiple vectors are currently available, including integratinglentivirus vectors and non-integrating adeno-associated virus (AAV)vectors. Over the past decade, AAVs have proven to be reliable,efficient, versatile, and safe tools to deliver, in a singleadministration, a transgene of interest to a variety of tissues, notablyincluding the CNS.

CNS-directed gene therapy studies have been focused mainly on four AAVserotypes: AAV2, AAV5, AAV8 and AAV9 (Burger et al., 2004. Mol Ther.10(2):302-17; Cearley & Wolfe, 2006. Mol Ther. 13(3):528-37; Taymans etal., 2007. Hum Gene Ther. 18(3):195-206; Cearley et al., 2008. Mol Ther.16(10):1710-8; Foust et al., 2009. Nat Biotechnol. 27(1):59-65; Aschaueret al., 2013. PLoS One. 8(9):e76310; Watakabe et al., 2015. NeurosciRes. 93:144-57).

Typically, CNS-directed AAV delivery has been performed locally to thebrain and/or spinal cord, since AAVs of all serotypes but AAV9 generallyfail to cross the blood-brain barrier, and therefore cannot beadministered non-invasively via the vascular system to reach targetcells in the CNS (Miyake et al., 2011. Brain Res. 1389:19-26). AAV9 inparticular, has been shown to be the most efficient at transducingneurons and astrocytes of the CNS after intracerebral or intrathecaladministration (Cearley & Wolfe, 2006. Mol Ther. 13(3):528-37; Gray etal., 2013. Gene Ther. 20(4):450-9). Still, the need for an AAV vectorwith wider transduction properties remains, in particular to addressdiseases that involve cells scattered throughout the CNS.

Injections to multiple sites of the CNS have been performed tocompensate for limited AAV spreading from the delivery site, and toprovide more extensive tissue coverage. However, even where suchstrategies may have been applied successfully to preclinical animalmodels (Vite et al., 2005. Ann Neurol. 57(3):355-64), translation tohumans has been hampered by the scaling-up of such invasive approaches.In this context, an AAV vector capable of achieving widespreadtransduction from a single, or very few, local administration point(s)in the CNS would be advantageous.

Intravascular delivery using AAV9 vectors has been proposed as analternative approach for achieving non-invasive, widespread transductionin the CNS (Bevan et al., 2011. Mol Ther. 19(11):1971-80). However,while this route of administration is extremely effective in mice,transduction in the CNS of larger animals has been much more restricted(Gray et al., 2011. Mol Ther. 19(6):1058-69; Samaranch et al., 2012. HumGene Ther. 23(4):382-9). This approach is further limited by theextremely large doses required to achieve transduction in the brain andthe resulting high off-target transduction of peripheral organs (Bevanet al., 2011. Mol Ther. 19(11):1971-80; Gray et al., 2011. Mol Ther.19(6):1058-69). Lastly, pre-existing immunity against AAV9 due toearlier exposure to the wild-type virus precludes the use of theintravascular route in as many as 43% human adults, because neutralizingantibodies have been shown to clear viral particles out of the systembefore they can reach the CNS (Boutin et al., 2010. Hum Gene Ther.21(6):704-12; Fu et al., 2017. Hum Gene Ther Clin Dev. 28:187-96).

Overall, immune response to AAVs remains an unresolved challenge totherapeutic efficacy, independent of the administration modality. Bothadaptative and innate cellular immune responses can hinder AAVtransduction efficiency, even in an immune-privileged organ such as theCNS (MacPhee et al. 2006. J Gene Med. 8:577-88; Samaranch et al. 2014.Mol Ther. 22(2):329-37). Therefore, an AAV vector capable of avoidingimmune detection, while ensuring both cell-specific and widespreadtransduction in the CNS, would be highly desirable.

Efforts over the years have focused on improving AAVs, throughmodifications of either their capsid or their expression cassette, toevade the immune system and enhance AAV cell transduction and transgeneexpression properties.

Current strategies for the development of capsid-modified AAV vectorsare based on three different approaches: (i) a rational design approach,based inter alia on the knowledge of AAV capsid binding to cellularreceptors to redirect AAV vector tropism (Rabinowitz et al., 1999.Virology. 265(2):274-85; Girod et al., 1999. Nat Med. 5(12):1438; Asokanet al., 2010. Nat Biotechnol. 28(1):79-82; Shen et al., 2013. J BiolChem. 288(40):28814-23; Albright et al., 2017. Mol Ther. 26(2):510-523;Tse et al., 2017. Proc Natl Acad Sci USA. 114(24):E4812-E4821); (ii) adirected evolution approach, based on random mutagenesis, capsidshuffling and random peptide insertions (Schaffer & Maheshri, 2004. ConfProc IEEE Eng Med Biol Soc. 5:3520-3; Koerber et al., 2006. Nat Protoc.1(2):701-6; Maheshri et al., 2006. Nat Biotechnol. 24(2):198-204; Peraboet al., 2008. Comb Chem High Throughput Screen. 11(2):118-26; Kwon &Schaffer, 2008. Pharm Res. 25(3):489-99; Gray et al., 2010. Mol Ther.18(3):570-8; Bartel et al., 2012. Gene Ther. 19(6):694-700; Marsic &Zolotukhin, 2016. Methods Mol Biol. 1382:151-73); and (iii) a chemicalcapsid modification approach, based on the tethering of chemical groupsto the AAV surface (Lee et al., 2005. Biotechnol Bioeng. 92:24-34;Maguire et al., 2012. Mol Ther. 20:960-71; Hurdy et al., 2016. GeneTher. 23:380-92; Katrekar et al., 2018. Sci Rep. 8).

Self-complementary AAVs (scAAVs), in which the expression cassette hasbeen modified to facilitate and accelerate gene expression once in thetarget cells, have been shown to drive faster onset and higher levels oftransgene expression in various tissues, as demonstrated for scAAV9 inthe CNS (Foust et al., 2008. Nat. Biotechnol. 27:56-65; Gray et al.,2011. Mol Ther. 19(6):1058-69). However, the reduced packagingcapacities of these vectors over traditional, single stranded AAVs (2.1kb vs 4.6 kb) limits their usefulness for the treatment of CNSindications.

International patent publication WO2017212019 describes certainsurface-modified AAV-derived vectors with improved virus-mediated genetransfer into specific cell types. However, WO2017212019 does notspecifically address CNS delivery of these surface-modified AAV vectors.

Here, the Inventors have surprisingly demonstrated that an AAV vectorcomprising surface-bound saccharides could transduce cells in the CNS.Interestingly, they have shown that the transduction of CNS cells wasnot only based on the modification of the AAV capsid, but also dependenton the route of administration.

Combining these two criteria, the Inventors have been able todemonstrate widespread transduction of the brain hemisphere with asingle injection of these modified AAV vectors directly to the CNS, butnot intracerebroventricularly. Thus, among other things, the presentdisclosure provides particular routes and/or procedures that, whenutilized to administer saccharide-conjugated AAVs (i.e., AAVs havingsurface-bound saccharide(s)) as described herein, can achieve effectiveand widespread CNS delivery, even from a single administration (e.g.,injection).

These results offer a promising outlook for gene therapy in the future,in particular for the treatment of diseases affecting the CNS.

SUMMARY

The present invention relates to a modified adeno-associated virus (AAV)vector for use in transducing a cell in the central nervous system (CNS)of a subject,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is to be administered directly to theCNS, and

wherein said modified AAV vector is not to be administeredintracerebroventricularly.

The present invention also relates to a method for transducing a cell inthe central nervous system (CNS) of a subject, comprising administeringa modified adeno-associated virus (AAV) vector to said subject,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is administered directly to the CNS,and

wherein said modified AAV vector is not administeredintracerebroventricularly.

The present invention also relates to a modified adeno-associated virus(AAV) vector for use in the prevention or treatment of a central nervoussystem (CNS) disease,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is to be administered directly to theCNS, and

wherein said modified AAV vector is not to be administeredintracerebroventricularly.

The present invention also includes methods of treating a CNS disease,for example by administering directly to a CNS site, other than byintracerebroventricular injection, an AAV vector that is a modified AAVvector in that it contains at least one surface-conjugated saccharide.

Moreover, the present invention provides improvements for administeringan AAV vector to the CNS, including by utilizing an AAV vector that is amodified AAV vector in that it contains at least one surface-conjugatedsaccharide; and administering the modified AAV vector other than byintracerebroventricular injection. The present disclosure also providesimprovements for delivering a transgene to the CNS, for example byincluding the transgene in an AAV vector that is a modified AAV vectorin that it contains at least one surface-conjugated saccharide; andadministering the modified AAV vector other than byintracerebroventricular injection.

In one embodiment, said CNS disease is a CNS infectious disease, a CNSdegenerative disease, a CNS auto-immune disease, a CNS tumor disease, acerebrovascular disease, a CNS injury or a CNS structural defect.

In one embodiment, said modified AAV vector is to be administeredintrastriatally, intrathalamically or intracisternally.

In one embodiment, said modified AAV vector is selected from AAV1, AAV2,AAV3, AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAV11 and AAV12; orpseudotypes, chimeras, and variants thereof.

In one embodiment, said modified AAV vector is an AAV2 vector.

In one embodiment, the surface-bound saccharide is selected from thegroup comprising monosaccharides, oligosaccharides and polysaccharides.

In one embodiment, the surface-bound saccharide is a hexose, preferablya mannose, galactose or N-acetylglucosamine.

As noted above, WO2017212019 describes certain surface-modifiedAAV-derived vectors with improved virus-mediated gene transfer intospecific cell types, which specifically are AAV that are surfacemodified with certain saccharide moieties. Among other things, thepresent disclosure expands these teachings, including by demonstratingeffective delivery with a range of saccharides and moreover establishingspecific utility for CNS delivery as described herein (e.g.,particularly when administered other than intracerebroventricularly),including for delivery to a variety of tissues, even distant from a siteof administration and/or even after only a single administration (e.g.,injection). In one embodiment, the surface-bound saccharide iscovalently bound to at least one capsid protein of the AAV vector,preferably to at least one surface-exposed amino acid residue of atleast one capsid protein of the AAV vector.

In one embodiment, the surface-bound saccharide is covalently boundthrough a linker.

In one embodiment, said modified AAV vector comprises at least onetransgene.

In one embodiment, said transgene comprises a cDNA, or a fragmentthereof, from a gene selected from the group comprising 3R tau, 4R tau,AARS, ABCD1, ACOX1, ADGRV1, ADRA2B, AGA, AGER, ALDH7A1, ALG13, ALS2,ANG, ANXA11, APP, ARHGEF9, ARSA, ARSB, ARV1, ASAH1, ASPA, ATN1, ATP10A,ATP13A2, ATXN1, ATXN2, ATXN3, BAX, BCL-2, BDNF, BICD2, C9orf72, CACNA1A,CACNA1H, CACNB4, CASR, CCNF, CDKL5, CERS1, CFAP410, CHCHD10, CHD2,CHMP2B, CHRNA2, CHRNA4, CHRNA7, CHRNB2, CLCN2a, CLN1, CLN2, CLN3, CLN5,CLN6, CLN8, CNTN2, CPA6, CSTB, CTNS, CTSA, CTSD, DAO, DCTN1, DEPDC5,DMD, DNAJB2, DNM1, DOCK7, DRD2, DYNC1H1, EEF1A2, EFHC1, EGLN1, EPHA4,EPM2A, ERBB4, FGF12, FIG4, FRRS1L, FTL, FUCA1, FUS, FXN, GAA, GABRA1,GABRB1, GABRB3, GABRD, GABRG2, GAL, GALC, GALNS, GBA, GFAP, GLA, GLB1,GLE1, GLT8D1, GNAO1, GNS, GOSR2, GPR98, GRIA1, GRIA2, GRIK1, GRIN1,GRIN2A, GRIN2B, GRIN2D, GSTM1, GUF1, GUSB, HCN1, HGSNAT, HNRNPA1, HTT,HYAL1, IDS, IDUA, IGHMBP2, IL-1, IT15, ITPA, JPH3, KCNA2, KCNB1, KCNC1,KCNMA1, KCNA2, KCNQ3, KCNT1, KCTD7, LAL, LAMP2, LGI1, LMNB2, LRRK2,MAN2B1, MAN2B2, MAN2C1, MANBA, MATR3, MBD5, MFSD8, NAGA, NAGLU, NECAP1,NEFH, NEK1, NEU1, NHLRC1, NPC1, NPC2, NR4A2, NTRK2, OCA2, OPTN, PARK2,PARK7, PCDH19, PEX1, PEX2, PEX3, PEX5, PEX6, PEX10, PEX11B, PEX12,PEX13, PEX14, PEX16, PEX19, PEX26, PFN1, PINK1, PLCB1, PNPO, PON1, PON2,PON3, PPARGC1A, PRDM8, PRICKLE1, PRKN, PRNP, PRPH, PRRT2, PSAP, S106β,SCARB2, SCN1A, SCN1B, SCN2A, SCN8A, SCN9A, SCN9Ab, SETX, SGSH, SIGMAR1,SIK1, SKP1, SLC1A1, SLC1A2, SLC2A1, SLC6A1, SLC9A6, SLC12A5, SLC13A5,SLC25A12, SLC25A22, SLCA17A5, SMN1, SMPD1, SNCA, SNRPN, SOD1, SPG11,SPTAN1, SQSTM1, ST3GAL3, ST3GAL5, STX1B, STXBP1, SYP, SYT1, SZT2, TAF15,TARDBP, TBC1D24, TBCE, TBK1, TBP, TITF-1, TREM2, UBA5, UBE1, UBE3A,UBQLN2, UCH-L1, UNC13A, VAPB, VCP, VPS35, WWOX, and XBP1.

In one embodiment, said CNS disease is selected from the groupcomprising acid lipase disease, acid maltase deficiency, acid storagedisease, acquired epileptiform aphasia, acute disseminatedencephalomyelitis, attention deficit hyperactivity disorder (ADHD),Adie's pupil, Adie's syndrome, adrenoleukodystrophy, agnosia, Aicardisyndrome, Aicardi-Goutieres syndrome disorder, Alexander disease,Alpers' disease, alternating hemiplegia, Alzheimer's disease,amyotrophic lateral sclerosis (ALS), anencephaly, aneurysm, Angelmansyndrome, angiomatosis, anoxia, antiphospholipid syndrome, aphasia,apraxia, arachnoiditis, Arnold-Chiari malformation, aromatic L-aminoacid decarboxylase deficiency (AADC deficiency), aspartylglucosaminuria,Asperger syndrome, ataxia, ataxia telangiectasia (Louis-Bar syndrome),ataxias and cerebellar or spinocerebellar degeneration, attentiondeficit-hyperactivity disorder, autism, autonomic dysfunction, Barthsyndrome, Batten disease, Becker's myotonia, Behcet's disease, Bell'spalsy, Bernhardt-Roth syndrome, Binswanger's disease, Bloch-Sulzbergersyndrome, Bradbury-Eggleston syndrome, Brown-Sequard syndrome,bulbospinal muscular atrophy, CADASIL, Canavan's disease, causalgia,cavernomas, cavernous angioma, central cervical cord syndrome, centralcord syndrome, central pontine myelinolysis, ceramidase deficiency,cerebellar degeneration, cerebellar hypoplasia, cerebral beriberi,cerebral gigantism, cerebral palsy, cerebro-oculo-facio-skeletalsyndrome (COFS), cholesterol ester storage disease, chorea,choreoacanthocytosis, chronic inflammatory demyelinating polyneuropathy(CIDP), chronic orthostatic intolerance, chronic pain, Cockayne syndrometype II, Coffin-Lowry syndrome, colpocephaly, congenital myasthenia,corticobasal degeneration, cranial arteritis, cree encephalitis,Creutzfeldt-Jakob disease, Cushing's syndrome, cystinosis, cytomegalicinclusion body disease, dancing eyes-dancing feet syndrome, Dandy-Walkersyndrome, Danon disease, Dawson disease, De Morsier's syndrome,Dejerine-Klumpke palsy, dementia, dentate cerebellar ataxia,dentatorubral atrophy, dermatomyositis, developmental dyspraxia, Devic'ssyndrome, diffuse sclerosis, dysautonomia, dysgraphia, dyslexia,dysphagia, dyspraxia, dyssynergia cerebellaris myoclonica, dyssynergiacerebellaris progressiva, epilepsy (including Amish infantile epilepsysyndrome [AIES], benign familial infantile seizures [BFIS], benignfamilial neonatal seizures [BFNS], childhood absence epilepsy [CAE],childhood-onset epileptic encephalopathy [COEE], Dravet syndrome [DS],early infantile epileptic encephalopathy [EIEE], familial adultmyoclonic epilepsy [FAME], familial febrile seizures [FFS], familialfocal epilepsy with variable foci [FFEVF], familial infantile myoclonicepilepsy [FIME], familial temporal lobe epilepsy [FTLE], focal epilepsyand speech disorder [FESD] with or without mental retardation,generalized epilepsy and paroxysmal dyskinesia [GEPD], generalizedepilepsy with febrile seizures plus [GEFS+], idiopathic generalizedepilepsy [IGE], juvenile absence epilepsy [JAE], juvenile myoclonicepilepsy [JME], myoclonic-atonic epilepsy [MAE], nocturnal frontal lobeepilepsy [NFLE], progressive myoclonic epilepsy [PME], pyridoxamine5′-phosphate oxidase deficiency [PNPOD], pyridoxine-dependent epilepsy[EPD] and severe myoclonic epilepsy of infancy [SMEI]), Fabry disease,Fahr's syndrome, familial dysautonomia, familial hemangioma, familialidiopathic basal ganglia calcification, familial periodic paralyses,familial spastic paralysis, Farber's disease, fibromuscular dysplasia,Fisher syndrome, floppy infant syndrome, Friedreich's ataxia,frontotemporal dementia, fucosidosis, galactosialidosis, Gaucherdisease, generalized gangliosidosis, Gerstmann's syndrome,Gerstmann-Straussler-Scheinker disease, giant axonal neuropathy, giantcell arteritis, giant cell inclusion disease, globoid cellleukodystrophy, glossopharyngeal neuralgia, glycogen storage disease,GM1 gangliosidosis, GM2 gangliosidosis (Tay-Sachs disease),Guillain-Barre syndrome, Hallervorden-Spatz disease, hemicraniacontinua, hemiplegia alterans, hereditary spastic paraplegia,heredopathia atactica polyneuritiformis, Holmes-Adie syndrome,holoprosencephaly, Hughes syndrome, Huntington's disease,hydranencephaly, hydromyelia, hypercortisolism, immune-mediatedencephalomyelitis, inclusion body myositis, incontinentia pigmenti,infantile hypotonia, infantile neuroaxonal dystrophy, iniencephaly,Isaac's syndrome, Joubert syndrome, Keams-Sayre syndrome, Kennedy'sdisease, Kinsbourne syndrome, Kleine-Levin syndrome, Klippel-Feilsyndrome, Klippel-Trenaunay syndrome (KTS), Kliiver-Bucy syndrome,Korsakoff's amnesic syndrome, Krabbe disease, Kugelberg-Welanderdisease, Lambert-Eaton myasthenic syndrome, Landau-Kleffner syndrome,lateral femoral cutaneous nerve entrapment, lateral medullary syndrome,Leigh's disease, Lennox-Gastaut syndrome, Lesch-Nyhan syndrome,Levine-Critchley syndrome, Lewy body dementia, lipoid proteinosis,lissencephaly, locked-in syndrome, Lou Gehrig's disease, lupus, Lymedisease, Machado-Joseph disease, macrencephaly, alpha-mannosidosis,beta-mannosidosis, Melkersson-Rosenthal syndrome, Menkes disease,meralgia paresthetica, metachromatic leukodystrophy, microcephaly,Miller Fisher syndrome, Moebius syndrome, mucopolysaccharidosis type I-H(Hurler syndrome), mucopolysaccharidosis type I-H/S (Hurler-Scheiesyndrome), mucopolysaccharidosis type IS (Scheie syndrome),mucopolysaccharidosis type II (Hunter syndrome), mucopolysaccharidosistype III-A (Sanfilippo syndrome A), mucopolysaccharidosis type III-B(Sanfilippo syndrome B), mucopolysaccharidosis type III-C(Sanfilipposyndrome C), mucopolysaccharidosis type III-D (Sanfilippo syndrome D),mucopolysaccharidosis type IV-B (Morquio syndrome B),mucopolysaccharidosis type VI (Maroteaux-Lamy syndrome),mucopolysaccharidosis type VII (Sly syndrome), mucopolysaccharidosistype IX (Natowicz syndrome), multiple sclerosis, muscular dystrophy,myasthenia gravis, myelinoclastic diffuse sclerosis, narcolepsy,neuroacanthocytosis, neurofibromatosis, neuroleptic malignant syndrome,neurosarcoidosis, Niemann-Pick disease, Ohtahara syndrome,olivopontocerebellar atrophy, opsoclonus myoclonus, O'Sullivan-McLeodsyndrome, pantothenate kinase-associated neurodegeneration,paraneoplastic syndromes, paresthesia, Parkinson's disease, paroxysmalchoreoathetosis, paroxysmal hemicrania, Parry-Romberg syndrome,Pelizaeus-Merzbacher disease, Pena Shokeir II syndrome, periventricularleukomalacia, phytanic acid storage disease, Pick's disease, piriformissyndrome, polymyositis, Pompe disease, post-polio syndrome, posteriorcortical atrophy, primary dentatum atrophy, primary lateral sclerosis,primary progressive aphasia, prion diseases, progressive hemifacialatrophy, progressive locomotor ataxia, progressive multifocalleukoencephalopathy, progressive sclerosing poliodystrophy, progressivesupranuclear palsy, prosopagnosia, Ramsay Hunt syndrome I, Ramsay Huntsyndrome II, Rasmussen's encephalitis, Refsum disease, Rett syndrome,Reye's syndrome, Riley-Day syndrome, Sandhoff disease, Schilder'sdisease, Seitelberger disease, Shy-Drager syndrome, Sjogren's syndrome,spasticity, spina bifida, spinal muscular atrophy, spinocerebellarataxia, spinocerebellar atrophy, spinocerebellar degeneration,Steele-Richardson-Olszewski syndrome, striatonigral degeneration,Sturge-Weber syndrome, tardive dyskinesia, tauopathy, Tay-Sachs disease,thoracic outlet syndrome, thyrotoxic myopathy, tic douloureux, Todd'sparalysis, trigeminal neuralgia, tropical spastic paraparesis, Troyersyndrome, vascular dementia, Von Economo's disease, Von Hippel-Lindaudisease (VHL), Von Recklinghausen's disease, Wallenberg's syndrome,Werdnig-Hoffman disease, Wernicke-Korsakoff syndrome, West syndrome,Whipple's disease, Williams syndrome, Wilson disease, Wolman's disease,X-linked spinal and bulbar muscular atrophy, and Zellweger syndrome.

In one embodiment, said transgene is under control of a CAG promoter.

The present invention relates to a modified adeno-associated virus (AAV)vector comprising at least one transgene,

wherein said modified AAV comprises at least one surface-boundsaccharide, and wherein said transgene comprises a cDNA, or a fragmentthereof, from a gene selected from the group comprising 3R tau, 4R tau,AARS, ABCD1, ACOX1, ADGRV1, ADRA2B, AGA, AGER, ALDH7A1, ALG13, ALS2,ANG, ANXA11, APP, ARHGEF9, ARSA, ARSB, ARV1, ASAH1, ASPA, ATN1, ATP10A,ATP13A2, ATX1N1, ATXN2, ATXN3, BAX, BCL-2, BDNF, BICD2, C9orf72,CACNA1A, CACNA1H, CACNB4, CASR, CCNF, CDKL5, CERS1, CFAP410, CHCHD10,CHD2, CHMP2B, CHRNA2, CHRNA4, CHRNA7, CHRNB2, CLCN2a, CLN1, CLN2, CLN3,CLN5, CLN6, CLN8, CNTN2, CPA6, CSTB, CTNS, CTSA, CTSD, DAO, DCTN1,DEPDC5, DMD, DNAJB2, DNM1, DOCK7, DRD2, DYNC1H1, EEF1A2, EFHC1, EGLN1,EPHA4, EPM2A, ERBB4, FGF12, FIG4, FRRS1L, FTL, FUCA1, FUS, FXN, GAA,GABRA1, GABRB1, GABRB3, GABRD, GABRG2, GAL, GALC, GALNS, GBA, GFAP, GLA,GLB1, GLE1, GLT8D1, GNAO1, GNS, GOSR2, GPR98, GRIA1, GRIA2, GRIK1,GRIN1, GRIN2A, GRIN2B, GRIN2D, GSTM1, GUF1, GUSB, HCN1, HGSNAT, HNRNPA1,HTT, HYAL1, IDS, IDUA, IGHMBP2, IL-1, IT15, ITPA, JPH3, KCNA2, KCNB1,KCNC1, KCNMA1, KCNA2, KCNQ3, KCNT1, KCTD7, LAL, LAMP2, LGI1, LMNB2,LRRK2, MAN2B1, MAN2B2, MAN2C1, MANBA, MATR3, MBD5, MFSD8, NAGA, NAGLU,NECAP1, NEFH, NEK1, NEU1, NHLRC1, NPC1, NPC2, NR4A2, NTRK2, OCA2, OPTN,PARK2, PARK7, PCDH19, PEX1, PEX2, PEX3, PEX5, PEX6, PEX10, PEX11B,PEX12, PEX13, PEX14, PEX16, PEX19, PEX26, PFN1, PINK1, PLCB1, PNPO,PON1, PON2, PON3, PPARGC1A, PRDM8, PRICKLE1, PRKN, PRNP, PRPH, PRRT2,PSAP, S106β, SCARB2, SCN1A, SCN1B, SCN2A, SCN8A, SCN9A, SCN9Ab, SETX,SGSH, SIGMAR1, SIK1, SKP1, SLC1A1, SLC1A2, SLC2A1, SLC6A1, SLC9A6,SLC12A5, SLC13A5, SLC25A12, SLC25A22, SLCA17A5, SMN1, SMPD1, SNCA,SNRPN, SOD1, SPG11, SPTAN1, SQSTM1, ST3GAL3, ST3GAL5, STX1B, STXBP1,SYP, SYT1, SZT2, TAF15, TARDBP, TBC1D24, TBCE, TBK1, TBP, TITF-1, TREM2,UBA5, UBE1, UBE3A, UBQLN2, UCH-L1, UNC13A, VAPB, VCP, VPS35, WWOX, andXBP1; preferably under control of a promoter.

The present invention relates to a kit or kit-of-parts suitable for:

-   -   transducing a cell in the central nervous system (CNS) of a        subject; and/or    -   delivering a transgene to the central nervous system (CNS) of a        subject; and/or    -   preventing and/or treating a central nervous system (CNS)        disease in a subject,

said kit comprising:

(a) the modified AAV vector according to the present invention,

(b) a device for CNS delivery of the modified AAV vectors, and

(c) optionally, instructions for CNS delivery of the modified AAVvector.

DETAILED DESCRIPTION

Among other things, the present disclosure provides an insight thatdevelopment of an AAV system with wider transduction properties could beparticularly useful and could address the source of a problem withexisting AAV strategies, especially in the context of CNS diseases thatmay involve cells scattered throughout the CNS.

Among other things, the present disclosure provides an insight that anAAV vector capable of achieving widespread transduction from a single,or very few, local administration point(s) in the CNS would beadvantageous and would solve a source of a problem with certain existingAAV strategies which for example may require or typically involveinjection to multiple sites in the CNS.

Among other things, the present disclosure provides an insight that anAAV vector capable of avoiding immune detection, while ensuring bothcell-specific and widespread transduction in the CNS, would beadvantageous and would solve a source of a problem with certain existingAAV strategies triggering immune responses.

The present invention relates to a modified adeno-associated virus (AAV)vector for use in transducing a cell in the central nervous system (CNS)of a subject,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is to be administered directly to theCNS, and

wherein said modified AAV vector is not to be administeredintracerebroventricularly.

The present invention also relates to the use of a modifiedadeno-associated virus (AAV) vector for transducing a cell in thecentral nervous system (CNS) of a subject,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is to be administered directly to theCNS, and

wherein said modified AAV vector is not to be administeredintracerebroventricularly.

The present invention also relates to a method of administering amodified adeno-associated virus (AAV) into a plurality of brain tissuesin the central nervous system (CNS) of a subject, the method comprisingadministering a modified adeno-associated virus (AAV) vector comprisingsaid transgene to said subject,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is administered directly to a CNS siteand at least one of the plurality of brain tissues is distant from theCNS site, and wherein said modified AAV vector is not administeredintracerebroventricularly.

In some embodiments, the brain tissues may be or include the striatum,the thalamus, the substantia nigra, the parietal cortices, thehippocampus and/or the globus pallidus. In some embodiments, the CNSsite may be in the striatum. In some embodiments, the CNS site may be inthe thalamus. In some embodiments, the CNS site may be in the cisternamagna. In some embodiments, the administering may be to a single CNSsite. In some embodiments, the administering may be to a plurality ofCNS sites, selected from the group consisting of the striatum andthalamus, and combinations thereof, or from the group consisting of thestriatum and thalamus and cisterna magna and combinations thereof. Insome embodiments, the administering may be by a single injection.

The present invention also relates to a method for transducing a cell inthe central nervous system (CNS) of a subject, comprising administeringa modified adeno-associated virus (AAV) vector to said subject,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is administered directly to the CNS,and

wherein said modified AAV vector is not administeredintracerebroventricularly.

The present invention also relates to a method for delivering atransgene into a cell in the central nervous system (CNS) of a subject,comprising administering a modified adeno-associated virus (AAV) vectorcomprising said transgene to said subject,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is administered directly to the CNS,and

wherein said modified AAV vector is not administeredintracerebroventricularly.

The present invention also relates to a method for delivering atransgene into a plurality of brain tissues in the central nervoussystem (CNS) of a subject, the method comprising administering amodified adeno-associated virus (AAV) vector comprising said transgeneto said subject,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is administered directly to a CNS siteand at least one of the plurality of brain tissues is distant from theCNS site, and

wherein said modified AAV vector is not administeredintracerebroventricularly.

In some embodiments, the brain tissues may be or include the striatum,the thalamus, the substantia nigra, the parietal cortices, thehippocampus and/or the globus pallidus. In some embodiments, the CNSsite may be in the striatum. In some embodiments, the CNS site may be inthe thalamus. In some embodiments, the CNS site may be in the cisternamagna. In some embodiments, the administering may be to a single CNSsite. In some embodiments, the administering may be to a plurality ofCNS sites, selected from the group consisting of the striatum andthalamus, and combinations thereof, or from the group consisting of thestriatum and thalamus and intra-cisterna magna and combinations thereof.In some embodiments, the administering may be by a single injection.

The present invention further relates to an in vitro method fortransducing a neuronal cell, comprising contacting said neuronal cellwith a modified adeno-associated virus (AAV) vector, wherein saidmodified AAV vector comprises at least one surface-bound saccharide.

As used herein, the term “central nervous system” or “CNS” refers toboth the brain and the spinal cord and contrasts with the “peripheralnervous system” or “PNS” which excludes the brain and the spinal cord.

As used herein, the term “subject” refers to a mammal, preferably ahuman. In one embodiment, a subject may be a “patient”, i.e., awarm-blooded animal, more preferably a human, who/which is awaiting thereceipt of, or is receiving medical care or was/is/will be the object ofa medical procedure, or is monitored for the development of a disease.

The term “mammal” refers here to any mammal, including humans, domesticand farm animals, and zoo, sports, or pet animals, such as dogs, cats,cattle, horses, sheep, pigs, goats, rabbits, etc. Preferably, the mammalis a primate, more preferably a human.

AAV vectors suitable in the present invention may comprise or be derivedfrom any natural or recombinant AAV serotype.

In one embodiment, the AAV vector according to the present invention isselected from natural serotypes AAV1, AAV2, AAV3, AAV4, AAV5, AAV6,AAV7, AAV8, AAV9, AAV10, AAV11 and AAV12; or pseudotypes, chimeras, andvariants thereof.

As used herein, the term “pseudotype” when referring to an AAV vector,or a “pseudotyped AAV vector”, refers to an AAV vector which comprisesthe genome of one AAV serotype packaged in the capsid of another AAVserotype. These pseudotypes are denoted using a slash or a hyphen, sothat “AAV2/5” or “AAV2-5” indicates an AAV vector comprising a serotype2 genome, packaged into a serotype 5 capsid.

Examples of pseudotyped AAV vectors include, but are not limited to,AAV2/1, AAV2/2, AAV2/3, AAV2/4, AAV2/5, AAV2/6, AAV2/7, AAV2/8 andAAV2/9.

As used herein, the term “chimera” when referring to an AAV vector, or a“chimeric AAV vector”, refers to an AAV vector which comprises a capsidcontaining VP1, VP2 and VP3 proteins from at least two different AAVserotypes; or alternatively, which comprises VP1, VP2 and VP3 proteins,at least one of which comprises at least a portion from another AAVserotype.

Examples of chimeric AAV vectors include, but are not limited to,AAV-DJ, AAV2G9, AAV2i8, AAV2i8G9, AAV8G9, and AAV9i1.

In one embodiment, the AAV vector according to the present invention isselected from the group comprising or consisting of AAV1, AAV2, AAV3,AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAV11, AAV12, AAV106.1/hu.37,AAV114.3/hu.40, AAV127.2/hu.41, AAV127.5/hu.42, AAV128.1/hu.43,AAV128.3/hu.44, AAV130.4/hu.48, AAV145.1/hu.53, AAV145.5/hu.54,AAV145.6/hu.55, AAV16.12/hu.11, AAV16.3, AAV16.8/hu.10, AAV161.10/hu.60,AAV161.6/hu.61, AAV1-7/rh.48, AAV1-8/rh.49, AAV2i8, AAV2i8G9,AAV2-15/rh.62, AAV223.1, AAV223.2, AAV223.4, AAV223.5, AAV223.6,AAV223.7, AAV2-3/rh.61, AAV24.1, AAV2-4/rh.50, AAV2-5/rh.51, AAV2.5T,AAV27.3, AAV29.3/bb.1, AAV29.5/bb.2, AAV2G9, AAV3B, AAV3.1/hu.6,AAV3.1/hu.9, AAV3-11/rh.53, AAV3-3, AAV33.12/hu.17, AAV33.4/hu.15,AAV33.8/hu.16, AAV3-9/rh.52, AAV3a, AAV3b, AAV4-19/rh.55, AAV42.12,AAV42-10, AAV42-11, AAV42-12, AAV42-13, AAV42-15, AAV42-1b, AAV42-2,AAV42-3a, AAV42-3b, AAV42-4, AAV42-5a, AAV42-5b, AAV42-6b, AAV42-8,AAV42-aa, AAV43-1, AAV43-12, AAV43-20, AAV43-21, AAV43-23, AAV43-25,AAV43-5, AAV4-4, AAV44.1, AAV44.2, AAV44.5, AAV46.2/hu.28,AAV46.6/hu.29, AAV4-8/rh.64, AAV4-9/rh.54, AAV52.1/hu.20,AAV52/hu.19,AAV5-22/rh.58, AAV5-3/rh.57, AAV54.1/hu.21,AAV54.2/hu.22,AAV54.4R/hu.27, AAV54.5/hu.23, AAV54.7/hu.24,AAV58.2/hu.25, AAV6.1, AAV6.1.2, AAV6.2, AAV7m8, AAV7.2, AAV7.3/hu.7,AAV-8b, AAV8G9, AAV-8h, AAV9i1, AAV9.11, AAV9.13, AAV9.16, AAV9.24,AAV9.45, AAV9.47, AAV9.61, AAV9.68, AAV9.84, AAV9.9, AAVcy.2, AAVcy.3,AAVcy.4, AAVcy.5, AAVcy.5R1, AAVcy.5R2, AAVcy.5R3, AAVcy.5R4, AAVcy.6,AAVhu.1, AAVhu.2, AAVhu.3, AAVhu.4, AAVhu.5, AAVhu.6, AAVhu.7, AAVhu.8,AAVhu.9, AAVhu.10, AAVhu.11, AAVhu.12, AAVhu.13, AAVhu.14/9, AAVhu.15,AAVhu.16, AAVhu.17, AAVhu.18, AAVhu.19, AAVhu.20, AAVhu.21, AAVhu.22,AAVhu.23.2, AAVhu.24, AAVhu.25, AAVhu.27, AAVhu.28, AAVhu.29, AAVhu.29R,AAVhu.31, AAVhu.32, AAVhu.34, AAVhu.35, AAVhu.37, AAVhu.39, AAVhu.40,AAVhu.41, AAVhu.42, AAVhu.43, AAVhu.44, AAVhu.44R1, AAVhu.44R2,AAVhu.44R3, AAVhu.45, AAVhu.46, AAVhu.47, AAVhu.48, AAVhu.48R1,AAVhu.48R2, AAVhu.48R3, AAVhu.49, AAVhu.51, AAVhu.52, AAVhu.53,AAVhu.54, AAVhu.55, AAVhu.56, AAVhu.57, AAVhu.58, AAVhu.60, AAVhu.61,AAVhu.63, AAVhu.64, AAVhu.66, AAVhu.67, AAVpi.1, AAVpi.2, AAVpi.3,AAVrh.2, AAVrh.2R, AAVrh.8, AAVrh.8R, AAVrh8R R533A mutant, AAVrh8RA586R mutant, AAVrh.10, AAVrh.12, AAVrh.13, AAVrh.13R, AAVrh.14,AAVrh.17, AAVrh.18, AAVrh.19, AAVrh.20, AAVrh.21, AAVrh.22, AAVrh.23,AAVrh.24, AAVrh.25, AAVrh.31, AAVrh.32, AAVrh.33, AAVrh.34, AAVrh.35,AAVrh.36, AAVrh.37, AAVrh.37R2, AAVrh.38, AAVrh.39, AAVrh.40, AAVrh.43,AAVrh.44, AAVrh.45, AAVrh.46, AAVrh.47, AAVrh.48, AAVrh.48.1,AAVrh.48.1.2, AAVrh.48.2, AAVrh.49, AAVrh.50, AAVrh.51, AAVrh.52,AAVrh.53, AAVrh.54, AAVrh.55, AAVrh.56, AAVrh.57, AAVrh.58, AAVrh.59,AAVrh.60, AAVrh.61, AAVrh.62, AAVrh.64, AAVrh.64R1, AAVrh.64R2,AAVrh.65, AAVrh.67, AAVrh.68, AAVrh.69, AAVrh.70, AAVrh.72, AAVrh.73,AAVrh.74, AAV-PHP.B, AAV-PHP.A, AAV-G2B-26, AAV-G2B-13, AAV-TH1.1-32,AAV-TH1.1-35, AAV-PHP.B2, AAV-PHP.B3, AAV-PHP.N/PHP.B-DGT,AAV-PHP.B-EST, AAV-PHP.B-GGT, AAV-PHP.B-ATP, AAV-PHP.B-ATT-T,AAV-PHP.B-DGT-T, AAV-PHP.B-GGT-T, AAV-PHP.B-SGS, AAV-PHP.B-AQP,AAV-PHP.B-QQP, AAV-PHP.B-SNP(3), AAV-PHP.B-SNP, AAV-PHP.B-QGT,AAV-PHP.B-NQT, AAV-PHP.B-EGS, AAV-PHP.B-SGN, AAV-PHP.B-EGT,AAV-PHP.B-DST, AAV-PHP.B-DST, AAV-PHP.B-STP, AAV-PHP.B-PQP,AAV-PHP.B-SQP, AAV-PHP.B-QLP, AAV-PHP.B-TMP, AAV-PHP.B-TTP,AAV-PHP.S/G2A12, AAV-G2A15/G2A3, AAV-G2B4, AAV-G2B5, PHP.S, AAAV, AAVA3.3, AAV A3.4, AAV A3.5, AAV A3.7, AAV CBr-7.3, AAV CBr-7.1, AAVCBr-7.10, AAV CBr-7.2, AAV CBr-7.4, AAV CBr-7.5, AAV CBr-7.7, AAVCBr-7.8, AAV CBr-B7.3, AAV CBr-B7.4, AAV CBr-E1, AAV CBr-E2, AAV CBr-E3,AAV CBr-E4, AAV CBr-E5, AAV CBr-e5, AAV CBr-E6, AAV CBr-E7, AAV CBr-E8,AAV CHt-1, AAV CHt-2, AAV CHt-3, AAV CHt-6.1, AAV CHt-6.10, AAV CHt-6.5,AAV CHt-6.6, AAV CHt-6.7, AAV CHt-6.8, AAV CHt-P1, AAV CHt-P2, AAVCHt-P5, AAV CHt-P6, AAV CHt-P8, AAV CHt-P9, AAV CKd-N4, AAV CKd-1, AAVCKd-10, AAV CKd-2, AAV CKd-3, AAV CKd-4, AAV CKd-6, AAV CKd-7, AAVCKd-8, AAV CKd-B1, AAV CKd-B2, AAV CKd-B3, AAV CKd-B4, AAV CKd-B5, AAVCKd-B6, AAV CKd-B7, AAV CKd-B8, AAV CKd-H1, AAV CKd-H2, AAV CKd-H3, AAVCKd-H4, AAV CKd-H5, AAV CKd-H6, AAV CKd-N3, AAV CKd-N9, AAV CLg-F1, AAVCLg-F2, AAV CLg-F3, AAV CLg-F4, AAV CLg-F5, AAV CLg-F6, AAV CLg-F7, AAVCLg-F8, AAV CLv-M9, AAV CLv-R6, AAV CLv-1, AAV CLv1-1, AAV CLv1-10, AAVCLv1-2, AAV CLv-12, AAV CLv1-3, AAV CLv-13, AAV CLv1-4, AAV CLv1-7, AAVCLv1-8, AAV CLv1-9, AAV CLv-2, AAV CLv-3, AAV CLv-4, AAV CLv-6, AAVCLv-8, AAV CLv-D1, AAV CLv-D2, AAV CLv-D3, AAV CLv-D4, AAV CLv-D5, AAVCLv-D6, AAV CLv-D7, AAV CLv-D8, AAV CLv-E1, AAV CLv-K1, AAV CLv-K3, AAVCLv-K6, AAV CLv-L4, AAV CLv-L5, AAV CLv-L6, AAV CLv-M1, AAV CLv-M11, AAVCLv-M2, AAV CLv-M5, AAV CLv-M6, AAV CLv-M7, AAV CLv-M8, AAV CLv-R1, AAVCLv-R2, AAV CLv-R3, AAV CLv-R4, AAV CLv-R5, AAV CLv-R7, AAV CLv-R8, AAVCLv-R9, AAV CSp-8.10, AAV CSp-1, AAV CSp-10, AAV CSp-11, AAV CSp-2, AAVCSp-3, AAV CSp-4, AAV CSp-6, AAV CSp-7, AAV CSp-8, AAV CSp-8.2, AAVCSp-8.4, AAV CSp-8.5, AAV CSp-8.6, AAV CSp-8.7, AAV CSp-8.8, AAVCSp-8.9, AAV CSp-9, AAV-LK08, AAV-LK15, AAV Shuffle 100-1, AAV Shuffle100-2, AAV Shuffle 100-3, AAV Shuffle 100-7, AAV Shuffle 10-2, AAVShuffle 10-6, AAV Shuffle 10-8, AAV SM 100-10, AAV SM 100-3, AAV SM10-1, AAV SM 10-2, AAV SM 10-8, AAV.VR-355, AAV-b, AAVC1, AAVC2, AAVC5,AAVCh.5, AAVCh.5R1, AAV-DJ, AAV-DJ8, AAVF1/HSC1, AAVF11/HSC11,AAVF12/HSC12, AAVF13/HSC13, AAVF14/HSC14, AAVF15/HSC15, AAVF16/HSC16,AAVF17/HSC17, AAVF2/HSC2, AAVF3, AAVF3/HSC3, AAVF4/HSC4, AAVF5,AAVF5/HSCS, AAVF6/HSC6, AAVF7/HSC7, AAVF8/HSC8, AAVF9/HSC9, AAV-h,AAVH-1/hu.1, AAVH2, AAVH-5/hu.3, AAVH6, AAVhE1.1, AAVhEr1.14,AAVhEr1.16, AAVhEr1.18, AAVhER1.23, AAVhEr1.35, AAVhEr1.36, AAVhEr1.5,AAVhEr1.7, AAVhEr1.8, AAVhEr2.16, AAVhEr2.29, AAVhEr2.30, AAVhEr2.31,AAVhEr2.36, AAVhEr2.4, AAVhEr3.1, AAVLG-10/rh.40, AAVLG-4/rh.38,AAVLG-9/hu.39, AAVLG-9/hu.39, AAV-LK01, AAV-LK02, AAV-LK03, AAV-LK03,AAV-LK04, AAV-LK05, AAV-LK06, AAV-LK07, AAV-LK09, AAV-LK10, AAV-LK11,AAV-LK12, AAV-LK13, AAV-LK14, AAV-LK16, AAV-LK17, AAV-LK18, AAV-LK19,AAVN721-8/rh.43, AAV-PAEC, AAV-PAEC12, AAV-PAEC11, AAV-PAEC2, AAV-PAEC4,AAV-PAEC6, AAV-PAEC7, AAV-PAEC8, Anc80, Anc80L65, Anc81, Anc82, Anc83,Anc84, Anc94, Anc110, Anc113, Anc126, Anc127, BAAV, BNP61 AAV, BNP62AAV, BNP63 AAV, bovine AAV, caprine AAV, Japanese AAV10 serotype, UPENNAAV10, VOY101, and VOY201.

In one embodiment, AAV variants include vectors which have beengenetically modified, e.g., by substitution, deletion or addition of oneor several amino acid residues in one of the capsid proteins. Examplesof such variants include, but are not limited to, AAV2 with any orseveral of Y444F, Y500F, Y730F and/or S662V mutations; AAV3 with any orseveral of Y705F, Y731F and/or T492V mutations; AAV6 with any or severalof S663V and/or T492V mutations.

In one embodiment, the AAV vector according to the present invention isAAV2.

In one embodiment, the AAV vector according to the present invention isAAV5.

In one embodiment, the AAV vector according to the present invention isAAV6.

In one embodiment, the AAV vector according to the present invention isAAV8.

In one embodiment, the AAV vector according to the present invention isAAV9.

In one embodiment, the AAV vector according to the present invention isAAVrh.10.

In one embodiment, the AAV vector according to the present invention isAnc80L65.

According to the present invention, the modified AAV vector comprises atleast one surface-bound saccharide or a derivative thereof.

As used herein, the term “surface-bound”, when referring to the at leastone saccharide, means that said at least one saccharide is bound to andexposed at the outer surface of the AAV vector.

Suitable examples of saccharides include, but are not limited to,monosaccharides, oligosaccharides, polysaccharides, and derivativesthereof.

As used herein, the term “derivatives” when referring tomonosaccharides, oligosaccharides or polysaccharides, is meant toencompass saccharides containing one or more non-hydroxyl group(s).Examples of such non-hydroxyl groups include, but are not limited to, ahydrogen, an alkyl, an amino group (such as e.g. NH2, an alkyl amino, adialkyl amino), an N-acetylamino group and/or a thiol group.

Monosaccharides, also called “simple sugar”, are the simplest form ofsugar and the most basic units of carbohydrates. Monosaccharides can beclassified by the number x of carbon atoms they contain, from 3(trioses), 4 (tetroses), 5 (pentoses), 6 (hexoses), 7 (heptoses), and soon.

Examples of monosaccharides include, but are not limited to,glycolaldehyde, glyceraldehyde, dihydroxyacetone, erythrose, threose,erythrulose, arabinose, lyxose, ribose, xylose, ribulose, xylulose,allose, altrose, galactose, glucose, gulose, idose, mannose, talose,fructose, psicose, sorbose, tagatose, mannoheptulose, and sedoheptulose.

Deoxymonosaccharides are common derivatives of monosaccharidesencompassed in the present invention, i.e., monosaccharides that havehad a hydroxyl group replaced with a hydrogen atom.

Examples of deoxymonosaccharides include, but are not limited to,deoxyribose, fucose, fuculose, rhamnose, quinovose, pneumose.

2-amino-2-deoxymonosaccharides are also common derivatives ofmonosaccharides encompassed in the present invention, i.e.,monosaccharides that have had a hydroxyl group replaced with an aminogroup.

Examples of 2-amino-2-deoxymonosaccharides include, but are not limitedto, glucosamine, galactosamine, and daunosamine, as well as theiracetylated forms, including, but not limited to, N-acetylglucosamine,and N-acetylgalactosamine.

It is to be understood that the monosaccharides and derivatives thereofmentioned herein also encompass acyclic (open-chain) forms and cyclicforms.

It is also to be understood that the monosaccharides and derivativesthereof mentioned herein also encompass D-stereoisomers andL-stereoisomers, as well as racemic mixtures of D- and L-stereoisomers.

It is also to be understood that the monosaccharides and derivativesthereof mentioned herein also encompass a-anomers and β-anomers, as wellas racemic mixtures of a- and β-anomers.

Oligosaccharides are saccharide polymers comprising a small number(typically from two to ten) of monosaccharides.

In one embodiment, the oligosaccharide according to the presentinvention comprises at least two, three, four, five, six, seven, eight,nine or ten monosaccharides chosen among the monosaccharides disclosedhereinabove, including their derivatives. Such oligosaccharide can be ahomooligosaccharides (i.e., composed of the same monosaccharide units,including their derivatives) or heterooligosaccharides (i.e., composedof at least two different monosaccharides, including their derivatives).

Examples of oligosaccharides include, but are not limited to,disaccharides, trisaccharides, tetrasaccharides, pentasaccharides,hexasaccharides, heptasaccharides, octasaccharides, nonasaccharides anddecasaccharides.

Specific examples of disaccharides include, but are not limited to,cellobiose, chitobiose, gentiobiose, gentiobiulose, isomaltose,kojibiose, lactose, lactulose, laminaribiose, maltose, maltulose,mannobiose, melibiose, melibiulose, nigerose, palatinose, rutinose,rutinulose, sophorose, sucrose, trehalose, turanose and xylobiose.

Specific examples of trisaccharides include, but are not limited to,kestose, maltotriose, maltotriulose, melezitose, nigerotriose andraffinose.

Specific examples of tetrasaccharides include, but are not limited to,lychnose, maltotetraose, nigerotetraose, nystose, sesamose andstachyose.

Other specific examples of oligosaccharides include, but are not limitedto, acarbose, fructooligosaccharide, galactooligosaccharide,isomaltooligosaccharide and maltodextrin.

Polysaccharides are saccharide polymers comprising a large number(typically more than ten) of monosaccharides. They range in structurefrom linear to highly branched.

In one embodiment, the polysaccharide according to the present inventioncomprises more than ten monosaccharides (such as, e.g., 11, 12, 13, 14,15, 16, 17, 18, 19, 20 or more) chosen among the monosaccharidesdisclosed hereinabove, including their derivatives. In a similar way asdescribed above for oligosaccharides, polysaccharides can behomopolysaccharides or heteropolysaccharides.

Examples of polysaccharides include, but are not limited to,beta-glucans, lentinan, sizofiran, zymosan, cellulose, hemicellulose,chitin, chitosan, dextrins, dextran, fructan, inulin, galactan, glucan,glycogen, levan β2→6, lignin, mannan, pectin, starch, amylopectin,amylose and xanthan gum.

In one embodiment, the saccharide or derivative thereof according to thepresent invention is a monosaccharide, preferably a hexose. Morepreferably the saccharide or derivative thereof according to the presentinvention is mannose, galactose or N-acetylglucosamine.

In one embodiment, the saccharide or derivative thereof is mannose. Inone embodiment, the saccharide or derivative thereof is galactose. Inone embodiment, the saccharide or derivative thereof isN-acetylglucosamine.

In one embodiment, the saccharide or derivative thereof according to thepresent invention is a deoxymonosaccharide, preferably fucose.

In other embodiments, the saccharide or derivative thereof is asaccharide containing a non-hydroxyl group which is a dialkyl aminogroup, preferably a desosamine.

In one embodiment, the at least one surface-bound saccharide or aderivative thereof is covalently bound to the AAV vector. In oneembodiment, the at least one surface-bound saccharide or a derivativethereof is not covalently bound to the AAV vector.

In one embodiment, the at least one surface-bound saccharide or aderivative thereof is covalently bound to the AAV vector through alinker or spacer. In one embodiment, the at least one surface-boundsaccharide or a derivative thereof is not covalently bound to the AAVvector through a linker or spacer.

The present invention is not limited to any particular linker or spacer.The use of a variety of linkers or spacers is contemplated, including,but not limited to, alkyl, ether, polyether, alkyl amide or acombination thereof. The use of a variety of alkyls is contemplated,including, but not limited to, —(CH₂)_(n)—, wherein “n” is from about 2to about 20 or more. The use of a variety of ethers and polyethers iscontemplated, including, but not limited to, —(OCH₂CH₂)_(n)—, wherein“n” is from about 1 to about 20 or more. The use of a variety of alkylamides is contemplated, including, but not limited to,—(CH₂)_(m)—C(O)NH—(CH₂)_(n)— and —(OCH₂CH₂)_(m)—C(O)NH—(OCH₂CH₂)_(n)—,wherein “m” and “n” can be the same or different and “m” and “n” arefrom about 1 to about 20 or more. The use of a variety of amides havingthe linking units of alkyl or ether bonds is contemplated, including,but not limited to, —R₁—C(O)NH—R₂—, wherein “R₁” and “R₂” are alkyls,ethers, or polyethers.

Certain examples of suitable linkers or spacer are described inWO2017212019.

In one embodiment, the linker is a poly-ethylene glycol (PEG)-basedlinker, such as e.g. a linker comprising a PEG3 spacer of formula—(OCH₂CH₂)₃—, or a linker comprising a PEGS spacer of formula—(OCH₂CH₂)₅—.

In some embodiments, the linker further comprises one or more aromaticgroup such as e.g. a phenyl. In one embodiment, the at least onesurface-bound saccharide or a derivative thereof is covalently bound toat least one capsid protein of the AAV vector.

AAV vectors are composed of a mixture of three capsid proteins, namedVP1, VP2 and VP3.

In one embodiment, the at least one surface-bound saccharide or aderivative thereof is covalently bound to at least one VP1 protein ofthe AAV vector. In one embodiment, the at least one surface-boundsaccharide or a derivative thereof is covalently bound to at least oneVP2 protein of the AAV vector. In one embodiment, the at least onesurface-bound saccharide or a derivative thereof is covalently bound toat least one VP3 protein of the AAV vector.

In one embodiment, the at least one surface-bound saccharide or aderivative thereof is covalently bound to at least one surface-exposedamino acid residue of at least one capsid protein of the AAV vector.

As used herein, the term “surface-exposed” refers to an amino acidresidue with a side chain that is at least partially exposed at theouter surface of the AAV vector.

In one embodiment, the at least one surface-bound saccharide or aderivative thereof is covalently bound to at least one surface-exposedamino acid residue containing a functional group of at least one capsidprotein of the AAV vector.

As used herein, the term “amino acid residue containing a functionalgroup” refers to amino acid residues comprising an amine group, a thiolgroup, an amide group, a hydroxyl group or the like.

In one embodiment, the amino acid residue containing a functional groupis any one of arginine, asparagine, aspartic acid, cysteine, glutamicacid, glutamine, histidine, lysine, serine, threonine, tryptophan,tyrosine, and mixtures thereof.

In a preferred embodiment, the at least one surface-bound saccharide ora derivative thereof is covalently bound to at least one surface-exposedlysine residue of at least one capsid protein of the AAV vector.

Means and methods for covalently coupling a saccharide to an AAV vector,such as to a surface-exposed amino acid residue of a capsid protein ofan AAV vector, are well known in the art. Such methods include, e.g.,conjugation with activated esters, sulfonyl chlorides orisothiocyanates; reductive alkylation; aza-Michael addition; azetidinonechemistry; benzoyl fluoride-based plug-and-play chemistry; or clickchemistry. Examples are given in, e.g., Sletten & Bertozzi, 2009. AngewChem Int Ed Engl. 48(38):6974-98.

Non-limiting examples of coupling reactions are shown on FIG. 17A. Tobetter illustrate said coupling reactions, non-limiting examples ofcoupling reactions between a saccharide moiety (such as e.g. mannose,herein taken as a non-limiting example of a saccharide moiety) and a AAVsurface-exposed primary amine (such as e.g. NH2), are shown on FIG. 17B.

According to the present invention, the modified AAV vectors is to beadministered directly to the CNS.

By “administered directly to the CNS”, it is meant administeredintraspinally or intracerebrally.

In one embodiment, the modified AAV vectors according to the presentinvention may be administered by intraspinal and/or intracerebraladministration.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated intraspinally.

In one embodiment, intraspinal administration comprises or consists ofintrathecal and epidural administration.

In one embodiment, intraspinal administration comprises or consists ofintrathecal administration.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated intracerebrally.

In one embodiment, intracerebral administration is at a site selectedfrom the group comprising or consisting of: striatum (such as, e.g.,putamen, caudate nucleus, nucleus accumbens, olfactory tubercle,external globus pallidus and/or internal globus pallidus), thalamus,hypothalamus, epithalamus, subthalamus, parenchyma, cerebrum, medulla,deep cerebellar nuclei (such as, e.g., substantia nigra, dentate,emboliform, globose and/or fastigii nucleus), cerebrospinal fluid (CSF),meninges, dura mater, arachnoid mater, pia mater, subarachnoid cisterns(such as, e.g., cisterna magna, pontine cistern, interpeduncularcistern, chiasmatic cistern, cistern of lateral cerebral fossa, superiorcistern and/or cistern of lamina terminalis), subarachnoid space,cortex, septum, pons, and cerebellum.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated intrastriatally (i.e., in the striatum,such as, e.g., in the putamen, caudate nucleus, nucleus accumbens,olfactory tubercle, external globus pallidus and/or internal globuspallidus), intrathalamically (i.e., in the thalamus), intracisternally(i.e., in the subarachnoid cisterns, such as, e.g., in the cisternamagna, pontine cistern, interpeduncular cistern, chiasmatic cistern,cistern of lateral cerebral fossa, superior cistern and/or cistern oflamina terminalis; preferably in the cisterna magna).

In one embodiment, the modified AAV vector according to the presentinvention is to be administered intraparenchymally.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated intrastriatally, intrathalamically,intracisternally or intrathecally.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated intrastriatally or intrathalamically.

According to the present invention, the modified AAV vector is not to beadministered intracerebroventricularly (i.e., not in the ventricularsystem, such as, e.g., not in the right lateral ventricle, left lateralventricle, third ventricle and/or fourth ventricle).

It is to be understood that the terms “administration” or“administered”, as used herein, are meant to encompass injections andinfusions, and any other means of administration known by the oneskilled in the art.

In one embodiment, the modified AAV vectors according to the presentinvention specifically transduce any or several of the following cells:neurons (such as, e.g., pyramidal neurons, Purkinje neurons, spindleneurons, medium spiny neurons, and/or interneurons [e.g., Golgi cells,Lugaro cells, basket cells, stellate cells, candelabrum cells, unipolarbrush cells, granule cells, Renshaw cells, 1a inhibitory neurons, 1binhibitory neurons, parvalbumin-expressing interneurons, CCK-expressinginterneurons, VIP-expressing interneurons, SOM-expressing interneurons,cholinergic interneurons, tyrosine hydroxylase-expressing interneurons,calretinin-expressing interneurons, or nitric oxide synthase-expressinginterneurons]), oligodendrocytes, astrocytes, microglial cells,ependymal cells, radial glia cells and/or pituicytes.

In one embodiment, the modified AAV vectors according to the presentinvention specifically transduce any or several of the following cells:neurons (such as, e.g., pyramidal neurons, Purkinje neurons, spindleneurons, medium spiny neurons, and/or interneurons [e.g., Golgi cells,Lugaro cells, basket cells, stellate cells, candelabrum cells, unipolarbrush cells, granule cells, Renshaw cells, 1a inhibitory neurons, 1binhibitory neurons, parvalbumin-expressing interneurons, CCK-expressinginterneurons, VIP-expressing interneurons, SOM-expressing interneurons,cholinergic interneurons, tyrosine hydroxylase-expressing interneurons,calretinin-expressing interneurons, or nitric oxide synthase-expressinginterneurons]).

In one embodiment, the modified AAV vectors according to the presentinvention do not specifically transduce any or several of the followingcells: oligodendrocytes, astrocytes, microglial cells, ependymal cells,radial glia cells and/or pituicytes.

The modified AAV vector described herein may be particularly useful ingene therapy.

Accordingly, the present invention also relates to the modified AAVvector according to the present invention, for use in gene therapy,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is to be administered intracerebrally,and

wherein said modified AAV vector is not to be administeredintracerebroventricularly.

The present invention also relates to a method of gene therapy in asubject in need thereof, comprising administering the modified AAVvector according to the present invention to said subject,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is administered intracerebrally, and

wherein said modified AAV vector is not administeredintracerebroventricularly.

In particular, the modified AAV vector described herein may beparticularly useful for preventing and/or treating a CNS disease.

Accordingly, the present invention also relates to the modified AAVvector according to the present invention, for use in the prevention ortreatment of a CNS disease,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is to be administered intracerebrally,and

wherein said modified AAV vector is not to be administeredintracerebroventricularly.

The present invention further relates to the use of the modified AAVvector according to the present invention, for the manufacture of amedicament for the prevention or treatment of a CNS disease,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is to be administered intracerebrally,and

wherein said modified AAV vector is not to be administeredintracerebroventricularly.

The present invention also relates to a method of preventing and/ortreating a CNS disease in a subject in need thereof, comprisingadministering the modified AAV vector according to the present inventionto said subject,

wherein said modified AAV vector comprises at least one surface-boundsaccharide,

wherein said modified AAV vector is administered intracerebrally, and

wherein said modified AAV vector is not administeredintracerebroventricularly.

As used herein, the terms “prevent”, “preventing” and “prevention” referto prophylactic and preventative measures, wherein the object is toreduce the chances that a subject will develop a given disease over agiven period of time. Such a reduction may be reflected, e.g., in adelayed onset of at least one symptom of the CNS disease in the subject.

As used herein, the terms “treating” or “treatment” or “alleviation”refer to therapeutic treatment, excluding prophylactic or preventativemeasures; wherein the object is to slow down (lessen) a given disease.Those in need of treatment include those already with the disease aswell those suspected to have the disease. A subject is successfully“treated” for a given disease if, after receiving a therapeutic amountof the modified AAV vector according to the present invention, saidsubject shows observable and/or measurable reduction in or absence ofone or more of the following: one or more of the symptoms associatedwith the CNS disease; reduced morbidity and mortality; and/orimprovement in quality of life issues. The above parameters forassessing successful treatment and improvement in the CNS disease arereadily measurable by routine procedures familiar to a physician.

According to these embodiments, the modified AAV vector according to thepresent invention comprises at least one transgene.

The term “transgene”, as used herein, refers to a polynucleotide that isintroduced into a cell and is capable of being transcribed into RNA andoptionally, translated and/or expressed under appropriate conditions. Inone aspect, it confers a desired property to a cell into which it wasintroduced, or otherwise leads to a desired therapeutic or prophylacticoutcome. In another aspect, the transgene may be incorporated, eitherentirely or partially, in the host cell's genome, such as, e.g., viacorrective gene editing using a CRISPR/Cas-based method, TALEN-basedmethod, ZFN-based method or the like, in presence of appropriate means.In still another aspect, it may be transcribed into a molecule thatmediates RNA interference (i.e., gene silencing), such as into a miRNA,siRNA, shRNA, piRNA or the like.

In one embodiment, the at least one transgene comprises a cDNA encodinga protein or a fragment thereof.

As used herein, the term “cDNA” refers to complementary DNA andcorresponds to a DNA molecule, usually synthesized from asingle-stranded RNA (such as, e.g., a messenger RNA [mRNA] or a microRNA[miRNA] template in a reaction catalyzed by a reverse transcriptase. Inparticular, when a cDNA is obtained from reverse transcription of amRNA, it does not comprise an entire gene coding from a protein, butonly the coding sequence of said protein (i.e., exons without introns).

In particular, a fragment of a cDNA can comprise a part of said cDNAencoding the N-terminal part or the C-terminal part of a protein. Suchfragment could be useful, e.g., in the case of large cDNAs which cannotbe carried by a single AAV vector and would thus require the use of,e.g., dual AAV vectors.

Alternatively, a fragment of a cDNA can comprise a part of said cDNAencoding a functional and/or structural portion of a protein.

In some embodiments, a fragment of a cDNA can comprise a sequenceencoding a functional and/or structural portion of an RNA molecule. Insome embodiments, such an RNA molecule may be a ribosomal RNA, transferRNA, small nuclear RNA, small nucleolar RNA, micro RNA, long non-codingRNA, short interfering RNA, guide RNA, and/or any functional RNAspecies.

In one embodiment, the cDNA is from a gene selected from the groupcomprising or consisting of 3R tau, 4R tau, AARS, ABCD1, ACOX1, ADGRV1,ADRA2B, AGA, AGER, ALDH7A1, ALG13, ALS2, ANG, ANXA11, APP, ARHGEF9,ARSA, ARSB, ARV1, ASAH1, ASPA, ATN1, ATP10A, ATP13A2, ATXN1, ATXN2,ATXN3, BAX, BCL-2, BDNF, BICD2, C9orf72, CACNA1A, CACNA1H, CACNB4, CASR,CCNF, CDKL5, CERS1, CFAP410, CHCHD10, CHD2, CHMP2B, CHRNA2, CHRNA4,CHRNA7, CHRNB2, CLCN2a, CLN1, CLN2, CLN3, CLN5, CLN6, CLN8, CNTN2, CPA6,CSTB, CTNS, CTSA, CTSD, DAO, DCTN1, DEPDC5, DMD, DNAK32, DNM1, DOCK7,DRD2, DYNC1H1, EEF1A2, EFHC1, EGLN1, EPHA4, EPM2A, ERBB4, FGF12, FIG4,FRRS1L, FTL, FUCA1, FUS, FXN, GAA, GABRA1, GABRB1, GABRB3, GABRD,GABRG2, GAL, GALC, GALNS, GBA, GFAP, GLA, GLB1, GLE1, GLT8D1, GNAO1,GNS, GOSR2, GPR98, GRIA1, GRIA2, GRIK1, GRIN1, GRIN2A, GRIN2B, GRIN2D,GSTM1, GUF1, GUSB, HCN1, HGSNAT, HNRNPA1, HTT, HYAL1, IDS, IDUA,IGHMBP2, IL-1, IT15, ITPA, JPH3, KCNA2, KCNB1, KCNC1, KCNMA1, KCNQ2,KCNQ3, KCNT1, KCTD7, LAL, LAMP2, LGI1, LMNB2, LRRK2, MAN2B1, MAN2B2,MAN2C1, MANBA, MATR3, MBD5, MFSD8, NAGA, NAGLU, NECAP1, NEFH, NEK1,NEU1, NHLRC1, NPC1, NPC2, NR4A2, NTRK2, OCA2, OPTN, PARK2, PARK7,PCDH19, PEX1, PEX2, PEX3, PEX5, PEX6, PEX10, PEX11B, PEX12, PEX13,PEX14, PEX16, PEX19, PEX26, PFN1, PINK1, PLCB1, PNPO, PON1, PON2, PON3,PPARGC1A, PRDM8, PRICKLE1, PRKN, PRNP, PRPH, PRRT2, PSAP, S106β, SCARB2,SCN1A, SCN1B, SCN2A, SCN8A, SCN9A, SCN9Ab, SETX, SGSH, SIGMAR1, SIK1,SKP1, SLC1A1, SLC1A2, SLC2A1, SLC6A1, SLC9A6, SLC12A5, SLC13A5,SLC25A12, SLC25A22, SLCA17A5, SMN1, SMPD1, SNCA, SNRPN, SOD1, SPG11,SPTAN1, SQSTM1, ST3GAL3, ST3GAL5, STX1B, STXBP1, SYP, SYT1, SZT2, TAF15,TARDBP, TBC1D24, TBCE, TBK1, TBP, TITF-1, TREM2, UBA5, UBE1, UBE3A,UBQLN2, UCH-L1, UNC13A, VAPB, VCP, VPS35, WWOX, and XBP1.

In one embodiment, the at least one transgene is under the control of atleast one element which enhances the transgene target specificity and/orexpression.

Examples of elements which enhance the transgene target specificityand/or expression include, but are not limited to, promoters,post-transcriptional regulatory elements (PREs), polyadenylation (polyA) signal sequences and upstream enhancers (USEs), CMV enhancers andintrons.

In one embodiment, the at least one transgene is under the control of atleast one promoter.

A person skilled in the art may recognize that expression of transgenesin a target cell may require a specific promoter, including, but notlimited to, a promoter that is species-specific, inducible,tissue-specific, or cell cycle-specific.

In one embodiment, the promoter is a promoter having a tropism for thecell being targeted.

In one embodiment, the promoter drives expression of the transgene for aperiod of time in targeted tissues.

Expression driven by a promoter may be for a period of 1 hour, 2, hours,3 hours, 4 hours, 5 hours, 6 hours, 7 hours, 8 hours, 9 hours, 10 hours,11 hours, 12 hours, 13 hours, 14 hours, 15 hours, 16 hours, 17 hours, 18hours, 19 hours, 20 hours, 21 hours, 22 hours, 23 hours, 1 day, 2 days,3 days, 4 days, 5 days, 6 days, 1 week, 8 days, 9 days, 10 days, 11days, 12 days, 13 days, 2 weeks, 15 days, 16 days, 17 days, 18 days, 19days, 20 days, 3 weeks, 22 days, 23 days, 24 days, 25 days, 26 days, 27days, 28 days, 29 days, 30 days, 31 days, 1 month, 2 months, 3 months, 4months, 5 months, 6 months, 7 months, 8 months, 9 months, 10 months, 11months, 1 year, 13 months, 14 months, 15 months, 16 months, 17 months,18 months, 19 months, 20 months, 21 months, 22 months, 23 months, 2years, 3 years, 4 years, 5 years, 6 years, 7 years, 8 years, 9 years, 10years or more than 10 years.

In one embodiment, the promoter is a weak promoter for sustainedexpression of the transgene.

Promoters may be naturally occurring or non-naturally occurring.Non-limiting examples of promoters include, but are not limited to,viral promoters, plant promoters and mammalian promoters. In oneembodiment, the promoter may be a human promoter. In one embodiment, thepromoter may be truncated or mutated.

Promoters which drive or promote expression in most tissues include, butare not limited to, human elongation factor 1a-subunit (EF1a),cytomegalovirus (CMV) immediate-early enhancer and/or promoter, chickenβ-actin (CBA) and its derivative CAG, β-glucuronidase (GUSB), andubiquitin C (UBC).

Tissue- or cell-specific expression elements can be used to restrictexpression to certain cell types, such as CNS promoters which can beused to restrict expression to neurons, subtypes of neurons, or glialcells such as astrocytes or oligodendrocytes.

Suitable examples of tissue- or cell-specific expression elements forneurons include, but are not limited to, neuron-specific enolase (NSE)promoter, platelet-derived growth factor (PDGF) promoter,platelet-derived growth factor B-chain (PDGF-β) promoter, synapsin (Syn)promoter, methyl-CpG binding protein 2 (MeCP2) promoter,Ca²⁺/calmodulin-dependent protein kinase II (CaMKII) promoter,metabotropic glutamate receptor 2 (mGluR2) promoter, neurofilament light(NFL) promoter, neurofilament heavy (NFH) promoter, β-globin minigeneηβ2 promoter, preproenkephalin (PPE) promoter, enkephalin (Enk) promoterand excitatory amino acid transporter 2 (EAAT2) promoter.

Suitable examples of tissue- or cell-specific expression elements forastrocytes include, but are not limited to, glial fibrillary acidicprotein (GFAP) promoter and EAAT2 promoter.

Suitable examples of tissue- or cell-specific expression elements foroligodendrocytes include, but are not limited to, myelin basic protein(MBP) promoter.

In one embodiment, the promoter is a ubiquitous promoter.

Suitable examples of ubiquitous promoters include, but are not limitedto, CMV, CBA (including its derivatives CAG, CBh, and the like), EF-1a,PGK, UBC, GUSB (hGBp), and UCOE.

In one embodiment, the promoter is not tissue- or cell-specific.

In one embodiment, the promoter is an engineered promoter.

In one embodiment, the promoter is a promoter from a naturally-expressedprotein.

In a preferred embodiment, the promoter is a CAG promoter (CMV immediateearly enhancer and chicken β-actin promoter).

In one embodiment, the CNS disease is a CNS infectious disease, a CNSdegenerative disease, a CNS auto-immune disease, a CNS tumor disease, acerebrovascular disease, a CNS injury or a CNS structural defect.

In one embodiment, the CNS disease is selected from the group comprisingor consisting of acid lipase disease, acid maltase deficiency, acidstorage disease, acquired epileptiform aphasia, acute disseminatedencephalomyelitis, attention deficit hyperactivity disorder (ADHD),Adie's pupil, Adie's syndrome, adrenoleukodystrophy, agnosia,

Aicardi syndrome, Aicardi-Goutieres syndrome disorder, Alexanderdisease, Alpers' disease, alternating hemiplegia, Alzheimer's disease,amyotrophic lateral sclerosis (ALS), anencephaly, aneurysm, Angelmansyndrome, angiomatosis, anoxia, antiphospholipid syndrome, aphasia,apraxia, arachnoiditis, Arnold-Chiari malformation, aromatic L-aminoacid decarboxylase deficiency (AADC deficiency), aspartylglucosaminuria,Asperger syndrome, ataxia, ataxia telangiectasia (Louis-Bar syndrome),ataxias and cerebellar or spinocerebellar degeneration, attentiondeficit-hyperactivity disorder, autism, autonomic dysfunction, Barthsyndrome, Batten disease, Becker's myotonia, Behcet's disease, Bell'spalsy, Bernhardt-Roth syndrome, Binswanger's disease, Bloch-Sulzbergersyndrome, Bradbury-Eggleston syndrome, Brown-Sequard syndrome,bulbospinal muscular atrophy, CADASIL, Canavan's disease, causalgia,cavernomas, cavernous angioma, central cervical cord syndrome, centralcord syndrome, central pontine myelinolysis, ceramidase deficiency,cerebellar degeneration, cerebellar hypoplasia, cerebral beriberi,cerebral gigantism, cerebral palsy, cerebro-oculo-facio-skeletalsyndrome (COFS), cholesterol ester storage disease, chorea,choreoacanthocytosis, chronic inflammatory demyelinating polyneuropathy(CIDP), chronic orthostatic intolerance, chronic pain, Cockayne syndrometype II, Coffin-Lowry syndrome, colpocephaly, congenital myasthenia,corticobasal degeneration, cranial arteritis, cree encephalitis,Creutzfeldt-Jakob disease, Cushing's syndrome, cystinosis, cytomegalicinclusion body disease, dancing eyes-dancing feet syndrome, Dandy-Walkersyndrome, Danon disease, Dawson disease, De Morsier's syndrome,Dejerine-Klumpke palsy, dementia, dentate cerebellar ataxia,dentatorubral atrophy, dermatomyositis, developmental dyspraxia, Devic'ssyndrome, diffuse sclerosis, dysautonomia, dysgraphia, dyslexia,dysphagia, dyspraxia, dyssynergia cerebellaris myoclonica, dyssynergiacerebellaris progressiva, epilepsy (such as, e.g., Amish infantileepilepsy syndrome [AIES], benign familial infantile seizures [BFIS],benign familial neonatal seizures [BFNS], childhood absence epilepsy[CAE], childhood-onset epileptic encephalopathy [COEE], Dravet syndrome[DS], early infantile epileptic encephalopathy [EIEE], familial adultmyoclonic epilepsy [FAME], familial febrile seizures [FFS], familialfocal epilepsy with variable foci [FFEVF], familial infantile myoclonicepilepsy [FIME], familial temporal lobe epilepsy [FTLE], focal epilepsyand speech disorder [FESD] with or without mental retardation,generalized epilepsy and paroxysmal dyskinesia [GEPD], generalizedepilepsy with febrile seizures plus [GEFS+], idiopathic generalizedepilepsy [IGE], juvenile absence epilepsy [JAE], juvenile myoclonicepilepsy [JME], myoclonic-atonic epilepsy [MAE], nocturnal frontal lobeepilepsy [NFLE], progressive myoclonic epilepsy [PME], pyridoxamine5′-phosphate oxidase deficiency [PNPOD], pyridoxine-dependent epilepsy[EPD] and severe myoclonic epilepsy of infancy [SMEI]), Fabry disease,Fahr's syndrome, familial dysautonomia, familial hemangioma, familialidiopathic basal ganglia calcification, familial periodic paralyses,familial spastic paralysis, Farber's disease, fibromuscular dysplasia,Fisher syndrome, floppy infant syndrome, Friedreich's ataxia,frontotemporal dementia, fucosidosis, galactosialidosis, Gaucherdisease, generalized gangliosidosis, Gerstmann's syndrome,Gerstmann-Straussler-Scheinker disease, giant axonal neuropathy, giantcell arteritis, giant cell inclusion disease, globoid cellleukodystrophy, glossopharyngeal neuralgia, glycogen storage disease,GM1 gangliosidosis, GM2 gangliosidosis (Tay-Sachs disease),Guillain-Barre syndrome, Hallervorden-Spatz disease, hemicraniacontinua, hemiplegia alterans, hereditary spastic paraplegia,heredopathia atactica polyneuritiformis, Holmes-Adie syndrome,holoprosencephaly, Hughes syndrome, Huntington's disease,hydranencephaly, hydromyelia, hypercortisolism, immune-mediatedencephalomyelitis, inclusion body myositis, incontinentia pigmenti,infantile hypotonia, infantile neuroaxonal dystrophy, iniencephaly,Isaac's syndrome, Joubert syndrome, Keams-Sayre syndrome, Kennedy'sdisease, Kinsbourne syndrome, Kleine-Levin syndrome, Klippel-Feilsyndrome, Klippel-Trenaunay syndrome (KTS), Kliiver-Bucy syndrome,Korsakoff s amnesic syndrome, Krabbe disease, Kugelberg-Welanderdisease, Lambert-Eaton myasthenic syndrome, Landau-Kleffner syndrome,lateral femoral cutaneous nerve entrapment, lateral medullary syndrome,Leigh's disease, Lennox-Gastaut syndrome, Lesch-Nyhan syndrome,Levine-Critchley syndrome, Lewy body dementia, lipoid proteinosis,lissencephaly, locked-in syndrome, Lou Gehrig's disease, lupus, Lymedisease, Machado-Joseph disease, macrencephaly, alpha-mannosidosis,beta-mannosidosis, Melkersson-Rosenthal syndrome, Menkes disease,meralgia paresthetica, metachromatic leukodystrophy, microcephaly,Miller Fisher syndrome, Moebius syndrome, mucopolysaccharidosis type I-H(Hurler syndrome), mucopolysaccharidosis type I-H/S (Hurler-Scheiesyndrome), mucopolysaccharidosis type IS (Scheie syndrome),mucopolysaccharidosis type II (Hunter syndrome), mucopolysaccharidosistype III-A (Sanfilippo syndrome A), mucopolysaccharidosis type III-B(Sanfilippo syndrome B), mucopolysaccharidosis type III-C(Sanfilipposyndrome C), mucopolysaccharidosis type III-D (Sanfilippo syndrome D),mucopolysaccharidosis type IV-B (Morquio syndrome B),mucopolysaccharidosis type VI (Maroteaux-Lamy syndrome),mucopolysaccharidosis type VII (Sly syndrome), mucopolysaccharidosistype IX (Natowicz syndrome), multiple sclerosis, muscular dystrophy,myasthenia gravis, myelinoclastic diffuse sclerosis, narcolepsy,neuroacanthocytosis, neurofibromatosis, neuroleptic malignant syndrome,neurosarcoidosis, Niemann-Pick disease, Ohtahara syndrome,olivopontocerebellar atrophy, opsoclonus myoclonus, O'Sullivan-McLeodsyndrome, pantothenate kinase-associated neurodegeneration,paraneoplastic syndromes, paresthesia, Parkinson's disease, paroxysmalchoreoathetosis, paroxysmal hemicrania, Parry-Romberg syndrome,Pelizaeus-Merzbacher disease, Pena Shokeir II syndrome, periventricularleukomalacia, phytanic acid storage disease, Pick's disease, piriformissyndrome, polymyositis, Pompe disease, post-polio syndrome, posteriorcortical atrophy, primary dentatum atrophy, primary lateral sclerosis,primary progressive aphasia, prion diseases, progressive hemifacialatrophy, progressive locomotor ataxia, progressive multifocalleukoencephalopathy, progressive sclerosing poliodystrophy, progressivesupranuclear palsy, prosopagnosia, Ramsay Hunt syndrome I, Ramsay Huntsyndrome II, Rasmussen's encephalitis, Refsum disease, Rett syndrome,Reye's syndrome, Riley-Day syndrome, Sandhoff disease, Schilder'sdisease, Seitelberger disease, Shy-Drager syndrome, Sjogren's syndrome,spasticity, spina bifida, spinal muscular atrophy, spinocerebellarataxia, spinocerebellar atrophy, spinocerebellar degeneration,Steele-Richardson-Olszewski syndrome, striatonigral degeneration,Sturge-Weber syndrome, tardive dyskinesia, tauopathy, Tay-Sachs disease,thoracic outlet syndrome, thyrotoxic myopathy, tic douloureux, Todd'sparalysis, trigeminal neuralgia, tropical spastic paraparesis, Troyersyndrome, vascular dementia, Von Economo's disease, Von Hippel-Lindaudisease (VHL), Von Recklinghausen's disease, Wallenberg's syndrome,Werdnig-Hoffman disease, Wernicke-Korsakoff syndrome, West syndrome,Whipple's disease, Williams syndrome, Wilson disease, Wolman's disease,X-linked spinal and bulbar muscular atrophy, Zellweger syndrome,multiple sclerosis atrophy, Lewis body dementia (LBD), and Angelmansyndrome.

As shown in the Examples, the inventors have shown that the modifiedadeno-associated virus (AAV) vectors of the invention are capable ofeffectively transducing certain areas of the brain, including thestriatum, the thalamus, the substantia nigra, the parietal cortices, thehippocampus and/or the globus pallidus. Thus, the modifiedadeno-associated virus (AAV) vectors of the invention are of greatinterest for targeting the striatum, the thalamus, the substantia nigra,the parietal cortices, the hippocampus and the globus pallidus, and/orfor treating diseases affecting the striatum, the thalamus, thesubstantia nigra, the parietal cortices, the hippocampus and the globuspallidus.

For instance, diseases affecting the striatum, the substantia nigra, thethalamus, the substantia nigra, the globus pallidus, the parietalcortices, and/or the hippocampus include, but are not limited to,Huntington's disease, Parkinson's disease, multiple sclerosis atrophy,Lewis Body Dementia (LBD), progressive supranuclear palsy and Angelmansyndrome. In some embodiments, the CNS disease is selected from thegroup consisting of Huntington's disease, Parkinson's disease, multiplesclerosis atrophy, Lewis body dementia (LBD), progressive supranuclearpalsy, frontotemporal dementia and Angelman syndrome.

The inventors have shown that the modified adeno-associated virus (AAV)vectors of the invention are capable of effectively transducing neurons.

Thus, in an embodiment, the CNS disease is a neurological disease or adisease affecting neurons.

The inventors have also shown that the modified adeno-associated virus(AAV) vectors of the invention are capable of effectively transducingneurons involved in the control of motor function. Thus, in anembodiment, the CNS disease is a motor neuron disease or syndrome.

Non-limiting examples of motor neuron diseases or syndrome include, butare not limited to, movement disorders, such as hypokinetic movementdisorders and hyperkinetic movement disorders.

Non-limiting examples of hypokinetic movement disorders include, but arenot limited to, Parkinson's disease (primary or idiopathicParkinsonism), secondary Parkinsonism, Parkinson plus syndromes,Hallevorden-Spatz disease, progressive supranuclear ophthalmoplegia andstriatonigral deneneration.

Non-limiting examples of hyperkinetic movement disorders include, butare not limited to, dystonia, drug induced dystonia, idiopathic familialdystonia, idiopathic nonfamilial dystonia, spasmodic torticollis,ideopathic orofacial dystonia, blepharospasm, extrapyramidal movementdisorders, tremor, essential tremor, drug induced tremor, myoclonus,opsoclonus, chorea, drug induced chorea, rheumatic chorea (Sydenham'schorea), Huntington's chorea, ballismus, hemiballismus, athetosis,dyskinesia, tardive dyskinesia, tic disorders, Tourette's syndrome,drug-induced tics and tics of organic origin, stereotypic movementdisorder, paroxysmal nocturnal limb movement, painful legs (or arms),moving toes (or fingers) syndrome, sporadic restless leg syndrome,familial restless leg syndrome, stiff-person syndrome, abnormal headmovements, cramp, spasm and fasciculation.

In one embodiment, the CNS disease is Alzheimer's disease and the atleast one transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of 3R tau, 4R tau, AGER, APP, BAX, BCL-2,CHRNA7, DRD2, GFAP, GRIA1, GRIA2, GRIK1, GRIN1, IL-1, SLC1A1, SYP andSYT1.

In one embodiment, the CNS disease is Parkinson's disease and the atleast one transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of ATP13A2, BDNF, EGLN1, GBA, GSTM1, LRRK2,NR4A2, NTRK2, PARK2, PARK7, PINK1, PRKN, S1068, SKP1, SNCA, VPS35 andUCH-L1.

In one embodiment, the CNS disease is Huntington's disease and the atleast one transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of ATN1, ATXN1, ATXN2, ATXN3, FTL, HTT, IT15,JPH3, PRNP, SLC2A3, TBP, TITF-1 and XBP1.

In one embodiment, the CNS disease is Friedreich's ataxia and the atleast one transgene comprises the cDNA of the FXN gene.

In one embodiment, the CNS disease is Canavan's Disease and the at leastone transgene comprises the cDNA of the ASPA gene.

In one embodiment, the CNS disease is muscular dystrophy and the atleast one transgene comprises the cDNA of the DMD gene.

In one embodiment, the CNS disease is spinal muscular atrophy and the atleast one transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of BICD2, CHCHD10, DNAJB2, DYNC1H1, IGHMBP2,SIGMAR1, SMN1, TBCE, VAPB and UBE1.

In one embodiment, the CNS disease is amyotrophic lateral sclerosis(ALS) and the at least one transgene comprises a cDNA of a gene selectedfrom the group comprising or consisting of ALS2, ANG, ANXA11, ATXN2,C9orf72, CHMP2B, CFAP410, CHCHD10, CCNF, DAO, DCTN1, EPHA4, ERBB4, FIG4,FUS, GLE1, GLT8D1, HNRNPA1, MATR3, NEFH, NEK1, OPTN, PFN1, PON1, PON2,PON3, PPARGC1A, PRPH, SETX, SIGMAR1, SMN1, SOD1, SPG11, SQSTM1, TAF15,TARDBP, TBK1, TREM2, UBQLN2, UNC13A, VAPB and VCP.

In one embodiment, the CNS disease is alpha-mannosidosis and the atleast one transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of MAN2B1, MAN2B2 and MAN2C1.

In one embodiment, the CNS disease is aspartylglucosaminuria and the atleast one transgene comprises the cDNA of the AGA gene.

In one embodiment, the CNS disease is Batten disease and the at leastone transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of CLN1, CLN2, CLN3, CLN5, CLN6, CLN8, CTSD andMFSD8.

In one embodiment, the CNS disease is beta-mannosidosis and the at leastone transgene comprises the cDNA of the MANBA gene.

In one embodiment, the CNS disease is cystinosis and the at least onetransgene comprises the cDNA of the CTNS gene.

In one embodiment, the CNS disease is Danon disease and the at least onetransgene comprises the cDNA of the LAMP2 gene.

In one embodiment, the CNS disease is Fabry disease and the at least onetransgene comprises the cDNA of the GLA gene.

In one embodiment, the CNS disease is Farber disease and the at leastone transgene comprises the cDNA of the ASAH1 gene.

In one embodiment, the CNS disease is fucosidosis and the at least onetransgene comprises the cDNA of the FUCA1 gene.

In one embodiment, the CNS disease is galactosialidosis and the at leastone transgene comprises the cDNA of the CTSA gene.

In one embodiment, the CNS disease is Gaucher disease and the at leastone transgene comprises the cDNA of the GBA gene.

In one embodiment, the CNS disease is Krabbe disease and the at leastone transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of GALC and PSAP.

In one embodiment, the CNS disease is metachromic leukodystrophy and theat least one transgene comprises the cDNA of the ARSA gene.

In one embodiment, the CNS disease is a mucopolysaccharidosis (such asany of Hurler syndrome, Hurler-Scheie syndrome, Scheie syndrome, Huntersyndrome, Sanfilippo syndrome A, B, C or D, Morquio syndrome B,Maroteaux-Lamy syndrome, Sly syndrome or Natowicz syndrome) and the atleast one transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of ARSB, GAA, GALNS, GLB1, GNS, GUSB, HGSNAT,HYAL1, IDS, IDUA, LAL, NAGA, NAGLU, NEU1, NPC1, NPC2, SGSH, SLCA17A5 andSMPD1.

In one embodiment, the CNS disease is spinocerebellar ataxia and the atleast one transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of ATXN1, ATXN2 and ATXN3.

In one embodiment, the CNS disease is adrenoleukodystrophy and the atleast one transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of ABCD1, ACOX1, PEX1, PEX2, PEX3, PEX5, PEX6,PEX10, PEX11B, PEX12, PEX13, PEX14, PEX16, PEX19 and PEX26.

In one embodiment, the CNS disease is Angelman syndrome and the at leastone transgene comprises a cDNA of a gene selected from the groupcomprising or consisting of ATP10A, MBD5, OCA2, SLC9A6, SNRPN and UBE3A.

In one embodiment, the CNS disease is epilepsy and the at least onetransgene comprises a cDNA of a gene selected from the group comprisingor consisting of AARS, ADGRV1, ADRA2B, ALDH7A1, ALG13, ARHGEF9, ARV1,CACNA1A, CACNA1H, CACNB4, CASR, CDKL5, CERS1, CHD2, CHRNA2, CHRNA4,CHRNB2, CLCN2a, CNTN2, CPA6, CSTB, DEPDC5, DNM1, DOCK7, EEF1A2, EFHC1,EPM2A, FGF12, FRRS1L, GABRA1, GABRB1, GABRB3, GABRD, GABRG2, GAL, GNAO1,GOSR2, GPR98, GRIN2A, GRIN2B, GRIN2D, GUF1, HCN1, ITPA, KCNA2, KCNB1,KCNC1, KCNMA1, KCNA2, KCNQ3, KCNT1, KCTD7, LGI1, LMNB2, NECAP1, NHLRC1,PCDH19, PLCB1, PNPO, PRDM8, PRICKLE1, PRRT2, SCARB2, SCN1A, SCN1B,SCN2A, SCN8A, SCN9A, SCN9Ab, SIK1, SLC12A5, SLC13A5, SLC1A2, SLC25A12,SLC25A22, SLC2A1, SLC6A1, SPTAN1, ST3GAL3, ST3GAL5, STX1B, STXBP1, SZT2,TBC1D24, UBA5, and WWOX.

One skilled in the art will recognize that a gene may have multipletranscriptional and/or translational isoforms, and that a transgenecomprising a cDNA of a gene described herein encompasses the potentialuse of transcriptional variants and/or splice variants of a target gene.

In one embodiment, the modified AAV vectors according to the presentinvention is to be administered directly to the CNS.

By “administered directly to the CNS”, it is meant administeredintraspinally or intracerebrally.

In one embodiment, the modified AAV vectors according to the presentinvention may be administered by intraspinal and/or intracerebraladministration.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated intraspinally.

In one embodiment, intraspinal administration comprises or consists ofintrathecal and epidural administration.

In one embodiment, intraspinal administration comprises or consists ofintrathecal administration.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated intracerebrally.

In one embodiment, intracerebral administration is at a site selectedfrom the group comprising or consisting of: striatum (such as, e.g.,putamen, caudate nucleus, nucleus accumbens, olfactory tubercle,external globus pallidus and/or internal globus pallidus), thalamus,hypothalamus, epithalamus, subthalamus, parenchyma, cerebrum, medulla,deep cerebellar nuclei (such as, e.g., substantia nigra, dentate,emboliform, globose and/or fastigii nucleus), cerebrospinal fluid (CSF),meninges, dura mater, arachnoid mater, pia mater, subarachnoid cisterns(such as, e.g., cisterna magna, pontine cistern, interpeduncularcistern, chiasmatic cistern, cistern of lateral cerebral fossa, superiorcistern and/or cistern of lamina terminalis), subarachnoid space,cortex, septum, pons, and cerebellum.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated intrastriatally (i.e., in the striatum,such as, e.g., in the putamen, caudate nucleus, nucleus accumbens,olfactory tubercle, external globus pallidus and/or internal globuspallidus), intrathalamically (i.e., in the thalamus), intracisternally(i.e., in the subarachnoid cisterns, such as, e.g., in the cisternamagna, pontine cistern, interpeduncular cistern, chiasmatic cistern,cistern of lateral cerebral fossa, superior cistern and/or cistern oflamina terminalis; preferably in the cisterna magna).

In one embodiment, the modified AAV vector according to the presentinvention is to be administered intraparenchymally.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated intrastriatally, intrathalamically,intracisternally or intrathecally.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated intrastriatally or intrathalamically.

In one embodiment, the modified AAV vector according to the presentinvention is not to be administered intracerebroventricularly (i.e., notin the ventricular system, such as, e.g., not in the right lateralventricle, left lateral ventricle, third ventricle and/or fourthventricle).

It is to be understood that the terms “administration” or“administered”, as used herein, are meant to encompass injections,infusions, and any other means of administration known by the oneskilled in the art.

In one embodiment, the modified AAV vector according to the presentinvention is to be administered to the subject in need thereof in atherapeutically effective amount.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated at a dose ranging from about 10⁸ viralgenomes (vg) to about 10¹⁵ vg, such as from about 10⁸ vg to about 10¹⁴vg, from about 10⁸ vg to about 10¹³ vg, from about 10⁸ vg to about 10¹²vg, from about 10⁸ vg to about 10¹¹ vg, from about 10⁸ vg to about 10¹⁰vg, from about 10⁸ vg to about 10⁹ vg, from about 10⁹ vg to about 10¹⁵vg, from about 10⁹ vg to about 10¹⁴ vg, from about 10⁹ vg to about 10¹³vg, from about 10⁹ vg to about 10¹² vg, from about 10⁹ vg to about 10¹¹vg, from about 10⁹ vg to about 10¹⁰ vg, from about 10¹⁰ vg to about 10¹⁵vg, from about 10¹⁰ vg to about 10¹⁴ vg, from about 10¹⁰ vg to about10¹³ vg, from about 10¹⁰ vg to about 10¹² vg, from about 10¹⁰ vg toabout 10¹¹ vg, from about 10¹¹ vg to about 10¹⁵ vg, from about 10¹¹ vgto about 10¹⁴ vg, from about 10¹¹ vg to about 10¹³ vg, from about 10¹¹vg to about 10¹² vg, from about 10¹² vg to about 10¹⁵ vg, from about10¹² vg to about 10¹⁴ vg, from about 10¹² vg to about 10¹³ vg, fromabout 10¹³ vg to about 10¹⁵ vg.

The term “vector genome”, abbreviated as “vg”, refers to one or morepolynucleotides comprising a set of the polynucleotide sequences of avector, e.g., a viral vector. A vector genome may be encapsidated in aviral particle. Depending on the particular viral vector, a vectorgenome may comprise single-stranded DNA, double-stranded DNA, orsingle-stranded RNA, or double-stranded RNA. A vector genome may includeendogenous sequences associated with a particular viral vector and/orany heterologous sequences inserted into a particular viral vectorthrough recombinant techniques (e.g., a transgene). In some embodiments,the nucleic acid titer of a viral vector may be measured in terms ofvg/mL. Methods suitable for measuring this titer are known in the art,and include, e.g., quantitative PCR.

As used herein, the term “about”, when set in front of a numericalvalue, means that said numerical value is approximate and smallvariations would not significantly affect the practice of the disclosedembodiments. Such small variations are, e.g., of ±1%, ±2%, ±3%, ±4%,±5%, ±6%, ±7%, ±8%, ±9%, ±10% or more.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated at a dose of about 1×10⁸ vg±0.5×10⁸,about 2×10⁸ vg±0.5×10⁸, about 2.75×10⁸ vg±0.5×10⁸, about 3×10⁸vg±0.5×10⁸, about 4×10⁸ vg±0.5×10⁸, about 5×10⁸ _(v)g±0.5×10⁸, about6×10⁸ vg±0.5×10⁸, about 7×10⁸ vg±0.5×10⁸, about 8×10⁸ vg±0.5×10⁸, about9×10⁸ vg±0.5×10⁸, about 1×10⁹ vg±0.5×10⁹, about 2×10⁹ vg±0.5×10⁹, about3×10⁹ vg±0.5×10⁹, about 4×10⁹ vg±0.5×10⁹, about 5×10⁹ vg±0.5×10⁹, about6×10⁹ vg±0.5×10⁹, about 7×10⁹ vg±0.5×10⁹, about 8×10⁹ vg±0.5×10⁹, about9×10⁹ vg±0.5×10⁹, about 1×10¹⁰ vg±0.5×10¹⁰, about 2×10¹⁰ vg±0.5×10¹⁰,about 3×10¹⁰ vg±0.5×10¹⁰, about 4×10¹⁰ vg±0.5×10¹⁰, about 5×10¹⁰vg±0.5×10¹⁰, about 6×10¹⁰ vg±0.5×10¹⁰, about 7×10¹⁰ vg±0.5×10¹⁰, about8×10¹⁰ vg±0.5×10¹⁰, about 9×10¹⁰ vg±0.5×10¹⁰, about 1 x10¹¹ vg±0.5×10¹¹,about 2×10¹¹ vg±0.5×10¹¹, about 3×10¹¹ vg±0.5×10¹¹, about 4×10¹¹vg±0.5×10¹¹, about 5×10¹¹ _(vg)±0.5×10¹¹, about 6×10¹¹ vg±0.5×10¹¹,about 7×10¹¹ vg±0.5×10¹¹, about 8×10¹¹ vg±0.5×10¹¹, about 9×10¹¹vg±0.5×10¹¹, about 1×10¹² vg±0.5×10¹², about 2×10¹² vg±0.5×10¹², about3×10¹² vg±0.5×10¹², about 4×10¹² vg±0.5×10¹², about 5×10¹²_(v)g±0.5×10¹², about 6×10¹² vg±0.5×10¹², about 7×10¹² vg±0.5×10¹²,about 8×10¹² vg±0.5×10¹², about 9×10¹² vg±0.5×10¹², about 1×10¹³vg±0.5×10¹³, about 2×10¹³ vg±0.5×10¹³, about 3×10¹³ vg±0.5×10¹³, about4×10¹³ vg±0.5×10¹³, about 5×10¹³ vg±0.5×10¹³, about 6×10¹³ vg±0.5×10¹³,about 7×10¹³ vg±0.5×10¹³, about 8×10¹³ vg±0.5×10¹³, about 9×10¹³vg±0.5×10¹³, about 1×10¹⁴ vg±0.5×10¹⁴, about 2×10¹⁴ vg±0.5×10¹⁴, about3×10¹⁴ vg±0.5×10¹⁴, about 4×10¹⁴ vg±0.5×10¹⁴, about 5×10¹⁴_(v)g±0.5×10¹⁴, about 6×10¹⁴ vg±0.5×10¹⁴, about 7×10¹⁴ vg±0.5×10¹⁴,about 8×10¹⁴ vg±0.5×10¹⁴, about 9×10¹⁴ vg±0.5×10¹⁴, about 1×10¹⁵vg±0.5×10¹⁵, about 2×10¹⁵ vg±0.5×10¹⁵, about 3×10¹⁵ vg±0.5×10¹⁵, about4×10¹⁵ vg±0.5×10¹⁵, about 5×10¹⁵ vg±0.5×10¹⁵, about 6×10¹⁵ vg±0.5×10¹⁵,about 7×10¹⁵ vg±0.5×10¹⁵, about 8×10¹⁵ vg±0.5×10¹⁵, about 9×10¹⁵vg±0.5×10¹⁵.

In one embodiment, the modified AAV vector according to the presentinvention is to be administrated at a dose of about 1×10⁶ vg/kg±0.5×10⁶,about 2×10⁶ vg/kg±0.5×10⁶, about 3×10⁶ vg/kg±0.5×10⁶, about 4×10⁶vg/kg±0.5×10⁶, about 5×10⁶ vg/kg±0.5×10⁶, about 6×10⁶ vg/kg±0.5×10⁶,about 7×10⁶ vg/kg±0.5×10⁶, about 8×10⁶ vg/kg±0.5×10⁶, about 9×10⁶vg/kg±0.5×10⁶, about 1×10⁷ vg/kg±0.5×10⁷, about 2×10⁷ vg/kg±0.5×10⁷,about 3×10⁷ vg/kg±0.5×10⁷, about 4×10⁷ vg/kg±0.5×10⁷, about 5×10⁷vg/kg±0.5×10⁷, about 6×10⁷ vg/kg±0.5×10⁷, about 7×10⁷ vg/kg±0.5×10⁷,about 8×10⁷ vg/kg±0.5×10⁷, about 9×10⁷ vg/kg±0.5×10⁷, about 1×10⁸vg/kg±0.5×10⁸, about 2×10⁸ vg/kg±0.5×10⁸, about 3×10⁸ vg/kg±0.5×10⁸,about 4×10⁸ vg/kg±0.5×10⁸, about 5×10⁸ vg/kg±0.5×10⁸, about 6×10⁸vg/kg±0.5×10⁸, about 7×10⁸ vg/kg±0.5×10⁸, about 8×10⁸ vg/kg±0.5×10⁸,about 9×10⁸ vg/kg±0.5×10⁸, about 1×10⁹ vg/kg±0.5×10⁹, about 2×10⁹vg/kg±0.5×10⁹, about 3×10⁹ vg/kg±0.5×10⁹, about 4×10⁹ vg/kg±0.5×10⁹,about 5×10⁹ vg/kg±0.5×10⁹, about 6×10⁹ vg/kg±0.5×10⁹, about 7×10⁹vg/kg±0.5×10⁹, about 8×10⁹ vg/kg±0.5×10⁹, about 9×10⁹ vg/kg±0.5×10⁹,about 1×10¹⁰ vg/kg±0.5×10¹⁰, about 2×10¹⁰ vg/kg±0.5×10¹⁰, about 3×10¹⁰vg/kg±0.5×10¹⁰, about 4×10¹⁰ vg/kg±0.5×10¹⁰, about 5×10¹⁰vg/kg±0.5×10¹⁰, about 6×10¹⁰ vg/kg±0.5×10¹⁰, about 7×10¹⁰vg/kg±0.5×10¹⁰, about 8×10¹⁰ vg/kg±0.5×10¹⁰, about 9×10¹⁰vg/kg±0.5×10¹⁰, about 1×10¹¹ vg/kg±0.5×10¹¹, about 2×10¹¹vg/kg±0.5×10¹¹, about 3×10¹¹ vg/kg±0.5×10¹¹, about 4×10¹¹vg/kg±0.5×10¹¹, about 5×10¹¹ vg/kg±0.5×10¹¹, about 6×10¹¹vg/kg±0.5×10¹¹, about 7×10¹¹ vg/kg±0.5×10¹¹, about 8×10¹¹vg/kg±0.5×10¹¹, about 9×10¹¹ vg/kg±0.5×10¹¹, about 1×10¹²vg/kg±0.5×10¹², about 2×10¹² vg/kg±0.5×10¹², about 3×10¹²vg/kg±0.5×10¹², about 4×10¹² vg/kg±0.5×10¹², about 5×10¹²vg/kg±0.5×10¹², about 6×10¹² vg/kg±0.5×10¹², about 7×10¹²vg/kg±0.5×10¹², about 8×10¹² vg/kg±0.5×10¹², about 9×10¹²vg/kg±0.5×10¹², about 1×10¹³ vg/kg±0.5×10¹³, about 2×10¹³vg/kg±0.5×10¹³, about 3×10¹³ vg/kg±0.5×10¹³, about 4×10¹³vg/kg±0.5×10¹³, about 5×10¹³ vg/kg±0.5×10¹³, about 6×10¹³vg/kg±0.5×10¹³, about 7×10¹³ vg/kg±0.5×10¹³, about 8×10¹³vg/kg±0.5×10¹³, about 9×10¹³ vg/kg±0.5×10¹³, about 1×10¹⁴vg/kg±0.5×10¹⁴.

The dose of modified AAV vectors required to achieve a desired effect ora therapeutic effect will vary based on several factors including, butnot limited to, the specific route of administration, the level of gene,RNA or protein expression required to achieve a therapeutic effect, thespecific disease being treated, and the stability of the gene, RNA orprotein product. The one skilled in the art can readily determine a doserange to treat a subject having a particular disease based on theaforementioned factors, as well as other factors that are well known inthe art.

The volume of modified AAV vectors administered to a subject will alsodepend, among other things, on the size of the subject, the dose of themodified AAV vector, and the route of administration. For example, forintracerebral administration, a volume ranging from about 1 μL to about10 μL or from about 10 μL to about 100 μL or from about 100 μL to about1000 μL or from about 1 mL to about 10 mL may be used.

In one embodiment, the volume of modified AAV vectors administered to asubject is of about 1 μL±0.5 μL, about 2 μL±0.5 μL, about 3 μL±0.5 μL,about 4 μL±0.5 μL, about 5 μL±0.5 μL, about 6 μL±0.5 μL, about 7 μL±0.5μL, about 8 μL±0.5 μL, about 9 μL±0.5 μL, about 10 μL±0.5 μL, about 15μL±5 μL, about 20 μL±5 μL, about 25 μL±5 μL, about 30 μL±5 μL, about 35μL±5 μL, about 40 μL±5 μL, about 45 μL±5 μL, about 50 μL±5 μL, about 55μL±5 μL, about 60 μL±5 μL, about 65 μL±5 μL, about 70 μL±5 μL, about 75μL±5 μL, about 80 μL±5 μL, about 85 μL±5 μL, about 90 μL±5 μL, about 95μL±5 μL, about 100 μL±5 μL, about 150 μL±50 μL, about 200 μL±50 μL,about 250 μL±50 μL, about 300 μL±50 μL, about 350 μL±50 μL, about 400μL±50 μL, about 450 μL±50 μL, about 500 μL±50 μL, about 550 μL±50 μL,about 600 μL±50 μL, about 650 μL±50 μL, about 700 μL±50 μL, about 750μL±50 μL, about 800 μL±50 μL, about 850 μL±50 μL, about 900 μL±50 μL,about 950 μL±50 μL, about 1000 μL±50 μL, about 1.5 mL±250 μL, about 2mL±250 μL, about 2.5 mL±250 μL, about 3 mL±250 μL, about 3.5 mL±250 μL,about 4 mL±250 μL, about 4.5 mL±250 μL, about 5 mL±250 μL, about 5.5mL±250 μL, about 6 mL±250 μL, about 6.5 mL±250 μL, about 7 mL±250 μL,about 7.5 mL±250 μL, about 8 mL±250 μL, about 8.5 mL±250 μL, about 9mL±250 μL, about 9.5 mL±250 μL, about 10 mL±250 μL.

The rate of administration of modified AAV vectors administered to asubject will also depend, among other things, on the size of thesubject, the dose of the modified AAV vector, the volume of the modifiedAAV vector, and the route of administration. For example, forintracerebral administration, a rate of administration ranging fromabout 0.1 μL/min to about 1 μL/min or from about 1 μL/min to about 5μL/min or from about 5 μL/min to about 10 μL/min may be used.

In one embodiment, the rate of administration of modified AAV vectorsadministered to a subject is of about 0.1 μL/min±0.05 μL/min, about 0.2μL/min±0.05 μL/min, about 0.3 μL/min±0.05 μL/min, about 0.4 μL/min±0.05μL/min, about 0.5 μL/min±0.05 μL/min, about 0.6 μL/min±0.05 μL/min,about 0.7 μL/min±0.05 μL/min, about 0.8 μL/min±0.05 μL/min, about 0.9μL/min±0.05 μL/min, 1 μL/min±0.5 μL/min, about 2 μL/min±0.5 μL/min,about 3 μL/min±0.5 μL/min, about 4 μL/min±0.5 μL/min, about 5 μL/min±0.5μL/min, about 6 μL/min±0.5 μL/min, about 7 μL/min±0.5 μL/min, about 8μL/min±0.5 μL/min, about 9 μL/min±0.5 μL/min, about 10 μL/min±0.5μL/min.

In one embodiment, the total dose or total volume of modified AAVvectors may be administered continuously (i.e., wherein the total doseor total volume of modified AAV vectors is injected in a single shot orinfusion); or discontinuously (i.e., wherein fractions of the total doseor total volume of modified AAV vectors are injected with intermittentperiods between each shot, preferably with short intermittent periodssuch as periods of time of 15 seconds, 30 seconds, 45 seconds, 1 minute,2 minutes, 3 minutes, 4 minutes, or 5 minutes between each shot orinfusion).

The present invention also relates to a modified adeno-associated virus(AAV) vector comprising at least one transgene.

In one embodiment, the modified AAV vector according to the presentinvention comprises at least one surface-bound saccharide or aderivative thereof, as described hereinabove.

In one embodiment, the at least one transgene comprises a cDNA encodinga protein or a fragment thereof.

In particular, a fragment of a cDNA can comprise a part of said cDNAencoding the N-terminal part or the C-terminal part of a protein. Suchfragment could be useful, e.g., in the case of large cDNAs which cannotbe carried by a single AAV vector and would thus require the use of dualAAV vectors.

Alternatively, a fragment of a cDNA can comprise a part of said cDNAencoding a functional and/or structural portion of a protein.

In one embodiment, the cDNA is from a gene selected from the groupcomprising or consisting of 3R tau, 4R tau, AARS, ABCD1, ACOX1, ADGRV1,ADRA2B, AGA, AGER, ALDH7A1, ALG13, ALS2, ANG, ANXA11, APP, ARHGEF9,ARSA, ARSB, ARV1, ASAH1, ASPA, ATN1, ATP10A, ATP13A2, ATXN1, ATXN2,ATXN3, BAX, BCL-2, BDNF, BICD2, C9orf72, CACNA1A, CACNA1H, CACNB4, CASR,CCNF, CDKL5, CERS1, CFAP410, CHCHD10, CHD2, CHMP2B, CHRNA2, CHRNA4,CHRNA7, CHRNB2, CLCN2a, CLN1, CLN2, CLN3, CLN5, CLN6, CLN8, CNTN2, CPA6,CSTB, CTNS, CTSA, CTSD, DAO, DCTN1, DEPDC5, DMD, DNAK32, DNM1, DOCK7,DRD2, DYNC1H1, EEF1A2, EFHC1, EGLN1, EPHA4, EPM2A, ERBB4, FGF12, FIG4,FRRS1L, FTL, FUCA1, FUS, FXN, GAA, GABRA1, GABRB1, GABRB3, GABRD,GABRG2, GAL, GALC, GALNS, GBA, GFAP, GLA, GLB1, GLE1, GLT8D1, GNAO1,GNS, GOSR2, GPR98, GRIA1, GRIA2, GRIK1, GRIN1, GRIN2A, GRIN2B, GRIN2D,GSTM1, GUF1, GUSB, HCN1, HGSNAT, HNRNPA1, HTT, HYAL1, IDS, IDUA,IGHMBP2, IL-1, IT15, ITPA, JPH3, KCNA2, KCNB1, KCNC1, KCNMA1, KCNQ2,KCNQ3, KCNT1, KCTD7, LAL, LAMP2, LGI1, LMNB2, LRRK2, MAN2B1, MAN2B2,MAN2C1, MANBA, MATR3, MBD5, MFSD8, NAGA, NAGLU, NECAP1, NEFH, NEK1,NEU1, NHLRC1, NPC1, NPC2, NR4A2, NTRK2, OCA2, OPTN, PARK2, PARK7,PCDH19, PEX1, PEX2, PEX3, PEX5, PEX6, PEX10, PEX11B, PEX12, PEX13,PEX14, PEX16, PEX19, PEX26, PFN1, PINK1, PLCB1, PNPO, PON1, PON2, PON3,PPARGC1A, PRDM8, PRICKLE1, PRKN, PRNP, PRPH, PRRT2, PSAP, S106β, SCARB2,SCN1A, SCN1B, SCN2A, SCN8A, SCN9A, SCN9Ab, SETX, SGSH, SIGMAR1, SIK1,SKP1, SLC1A1, SLC1A2, SLC2A1, SLC6A1, SLC9A6, SLC12A5, SLC13A5,SLC25A12, SLC25A22, SLCA17A5, SMN1, SMPD1, SNCA, SNRPN, SOD1, SPG11,SPTAN1, SQSTM1, ST3GAL3, ST3GAL5, STX1B, STXBP1, SYP, SYT1, SZT2, TAF15,TARDBP, TBC1D24, TBCE, TBK1, TBP, TITF-1, TREM2, UBA5, UBE1, UBE3A,UBQLN2, UCH-L1, UNC13A, VAPB, VCP, VPS35, WWOX, and XBP1.

In one embodiment, the at least one transgene is under the control of atleast one element which enhances the transgene target specificity and/orexpression.

Examples of such elements which enhances the transgene targetspecificity and/or expression have been described hereinabove, and applymutatis mutandis.

In one embodiment, the modified AAV vector comprising at least onetransgene according to the present invention is part of a composition.The invention thus relates to a composition comprising the modified AAVvector comprising at least one transgene according to the presentinvention.

In one embodiment, the modified AAV vector comprising at least onetransgene according to the present invention is part of a medicament.The invention thus relates to a medicament comprising the modified AAVvector comprising at least one transgene according to the presentinvention.

In one embodiment, the composition is a pharmaceutical composition andfurther comprises at least one pharmaceutically acceptable excipient,carrier, and/or preservative. The invention thus relates to apharmaceutical composition comprising the modified AAV vector comprisingat least one transgene according to the present invention, and at leastone pharmaceutically acceptable excipient, carrier, and/or preservative.

The term “pharmaceutically acceptable”, when referring to excipients,carriers, and/or preservatives, is meant to define molecular entitiesand compositions that do not produce an allergic or similar untowardreaction when administered to a subject, preferably a human. For humanadministration, pharmaceutical compositions should meet sterility,pyrogenicity, and general safety and purity standards as required byregulatory offices, such as, for example, FDA Office or EMA.

Pharmaceutically acceptable excipients, carriers and preservatives thatmay be used in these compositions include, but are not limited to, ionexchangers, alumina, aluminum stearate, lecithin, proteins (such as,e.g., serum albumin, gelatin, immunoglobulins and the like), buffersubstances (such as, e.g., phosphates, citrates or other organic acids,and the like), amino acids (such as, e.g., glycine, glutamine,asparagine, arginine, lysine and the like), antioxidants (such as, e.g.,ascorbic acid and the like), chelating agents (such as, e.g., EDTA),sorbic acid, potassium sorbate, partial glyceride mixtures of saturatedvegetable fatty acids, water, salts or electrolytes (such as, e.g.,protamine sulfate, disodium hydrogen phosphate, potassium hydrogenphosphate, sodium chloride, zinc salts, colloidal silica, magnesiumtrisilicate and the like), hydrophilic polymers (such as, e.g.,polyvinylpyrrolidone, polyethylene-polyoxypropylene block polymers andthe like), cellulose-based substances (such as, e.g., sodiumcarboxymethylcellulose), polyacrylates, waxes, nonionic surfactants(such as, e.g., Tween, pluronics, polyethylene glycol and the like) andwool fat.

In one embodiment, the pharmaceutical composition according to thepresent invention comprise vehicles which are pharmaceuticallyacceptable for a formulation capable of being injected to a subject.These may be in particular isotonic, sterile, saline solutions(monosodium or disodium phosphate, sodium, potassium, calcium ormagnesium chloride and the like or mixtures of such salts), or dry,especially freeze-dried compositions which upon addition, depending onthe case, of sterilized water or physiological saline, permit theconstitution of injectable solutions.

In one embodiment, the pharmaceutical composition according to thepresent invention comprise one or more agents that promote the entry ofthe modified AAV vector described herein into a mammalian cell, such as,e.g., natural and/or synthetic polymers, such as poloxamer, chitosan,cyclodextrins, dendrimers, poly(lactic-co-glycolic acid) polymers, andthe like.

The present invention also relates to kits and kits-of-parts, for:

-   -   transducing a cell in the central nervous system (CNS) of a        subject; and/or    -   delivering a transgene to the central nervous system (CNS) of a        subject; and/or    -   preventing and/or treating a central nervous system (CNS)        disease in a subject.

In one embodiment, the kits or kits-of-parts comprise the modified AAVvectors or the composition according to the present invention.

In one embodiment, the kits or kits-of-parts comprise a device for CNSdelivery of the modified AAV vectors or the composition according to thepresent invention.

Devices for CNS delivery are known in the art and may employ a pump(e.g., an osmotic and/or infusion pump, as described below) and/or aninjection device (e.g., a catheter, a cannula, a needle, a syringe, andthe like).

Optionally, an imaging technique may be used to guide the injectiondevice and/or monitor delivery of the composition. CNS delivery mayinclude delivery by stereotaxic injection, or by convection enhanceddelivery (CED). The injection device may be inserted into the CNS tissuein the subject. The one skilled in the art is able to determinedsuitable coordinates for positioning the injection device in the targetCNS tissue. In one embodiment, positioning is accomplished through ananatomical map obtained, e.g., by CT and/or MRI imaging of the subject'sbrain to guide the injection device to the target CNS tissue.

In one embodiment, intraoperative magnetic resonance imaging (iMRI)and/or real-time imaging of the delivery may be performed. In oneembodiment, the device is used to administer the modified AAV vectors asdescribed herein. iMRI is known in the art as a technique for MRI-basedimaging of a subject during surgery, which helps confirm a successfulsurgical procedure (e.g., to deliver the modified AAV vectors to theCNS) and reduces the risk of damaging other parts of the tissue. In oneembodiment, a tracing agent (such as, e.g., an MRI contrast enhancingagent) may be co-delivered with the modified AAV vectors to provide forreal-time monitoring of tissue distribution of the vectors. Use of atracing agent may inform the cessation of delivery. Other tracing andimaging means known in the art may also be used to follow modified AAVvector distribution.

In one embodiment, the modified AAV vectors according to the presentinvention may be administered by standard stereotaxic injection usingdevices and methods known in the art for delivery of AAV vectors.Generally, these methods may use an injection device, a planning systemfor translating a region of the tissue targeted for delivery into aseries of coordinates (e.g., parameters along the latero-lateral,dorso-ventral, and rostro-caudal axes), and a device for stereotaxiclocalization according to the planned coordinates (e.g., a stereotaxicdevice, optionally including the probe and a structure for fixing thehead in place in alignment with the coordinate system). A non-limitingexample of a system that may be useful for MRI-guided surgery and/orstereotaxic injection is the ClearPoint® system (MRI Interventions,Memphis, Tenn.).

Another exemplary and non-limiting method for delivering the modifiedAAV vectors according to the present invention to the CNS is convectionenhanced delivery. As used herein, the term “convection enhanceddelivery” or “CED” may refer to delivery of a therapeutic agent to theCNS by infusion at a rate in which hydrostatic pressure leads toconvective distribution. Any suitable flow rate can be used such thatthe intracranial pressure is maintained at suitable levels so as not toinjure the brain tissue. CED may be accomplished, for example, by usinga suitable catheter or cannula (e.g., a step-design reflux-free cannula)through positioning the tip of the cannula at least in close proximityto the target CNS tissue (e.g., the tip is inserted into the CNStissue). After the cannula is positioned, it is connected to a pumpwhich delivers the therapeutic agent through the cannula tip to thetarget CNS tissue. A pressure gradient from the tip of the cannula maybe maintained during infusion. In one embodiment, infusion may bemonitored by a tracing agent detectable by an imaging method such asintraoperative MRI (iMRI) or another real-time MRI technique.

CED is based on pumping an infusate (e.g., the composition comprisingthe modified AAV vectors according to the present invention) into theCNS under pressure in which the hydrostatic pressure of the interstitialfluid is overcome. This brings the infusate into contact with the CNSperivasculature, which is utilized like a pump to distribute theinfusate through convection and enhance the extent of its delivery.

In one embodiment, the kits further include instructions for CNSdelivery of the modified AAV vectors or the composition according to thepresent invention. In one embodiment, the kits comprise instructions forpreventing and/or treating a CNS disease as described herein, using theuses and methods described herein.

The kits described herein may further include other materials desirablefrom a commercial and user standpoint, including buffers, diluents,filters, needles, syringes, and package inserts with instructions forperforming any methods described herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view of one suitable way to synthetizemannosylated rAAV2 vectors. (H₂N)— represents a surface-exposed primaryamine reacting with the isothiocyanate (N═C═S) reactive group to couplethe mannose moiety. For the purposes of this illustration, only twomannose residues are shown bound to the AAV capsid. Black arrowsschematically indicate other mannose moieties.

FIG. 2 is a set of three immunohistochemistry photographs (in color),showing the GFP staining of mouse brain slices from the G1 [Vehicle], G2[AAV2-GFP] and G3 [mannose AAV2-GFP] group, 48 days after intrastriatalinjection.

FIG. 2A: immunohistochemistry photograph (in color) of mouse brainslices from the G1 group.

FIG. 2B: immunohistochemistry photograph (in color) of mouse brainslices from the G2 group.

FIG. 2C: immunohistochemistry photograph (in color) of mouse brainslices from the G3 group.

FIG. 3 is a set of two graphs showing the statistical analyses of thevolume of GFP transduction in the striatum (injection site) andsubstantia nigra in mouse brains from the G1 [Vehicle], G2 [wt AAV2],and G3 [man AAV2] group, 48 days after intrastriatal injection. Barsrepresent the group mean; dots represent the individual animal values.The data were analyzed with one-way ANOVA followed by Tukey's multiplecomparisons. * p<0.05, *** p<0.001, **** p<0.0001 cf. group G1; and ##p<0.01, #### p<0.0001 cf. group G2.

FIG. 3A: statistical analyses of the volume of GFP transduction in thestriatum.

FIG. 3B: statistical analyses of the volume of GFP transduction in thesubstantia nigra.

FIG. 4 is a set of three immunohistochemistry photographs (in color),showing the GFP staining of mouse brain slices from the G4 [Vehicle], G5[AAV2-GFP] and G6 [mannose AAV2-GFP] group, 48 days after intrathalamicinjection.

FIG. 4A: immunohistochemistry photograph (in color) of mouse brainslices from the G4 group.

FIG. 4B: immunohistochemistry photograph (in color) of mouse brainslices from the G5 group.

FIG. 4C: immunohistochemistry photograph (in color) of mouse brainslices from the G6 group.

FIG. 5 is a set of two graphs showing the statistical analyses of thevolume of GFP transduction in the thalamus (injection site) andsubstantia nigra in mouse brains from the G4 [Vehicle], G5 [wt AAV2],and G6 [man AAV2] group, 48 days after intrathalamic injection. Barsrepresent the group mean; dots represent the individual animal values.The data were analyzed with one-way ANOVA followed by Tukey's multiplecomparisons. ** p<0.01, **** p<0.0001 cf. group G4; and #### p<0.0001cf. group G5.

FIG. 5A: statistical analyses of the volume of GFP transduction in thethalamus.

FIG. 5B: statistical analyses of the volume of GFP transduction in thesubstantia nigra.

FIG. 6 is a set of three immunohistochemistry photographs (in color),showing the GFP staining of mouse brain slices from the G7 [Vehicle], G8[AAV2-GFP] and G9 [mannose AAV2-GFP] group, 48 days afterintracerebroventricular injection.

FIG. 6A: immunohistochemistry photograph (in color) of mouse brainslices from the G7 group.

FIG. 6B: immunohistochemistry photograph (in color) of mouse brainslices from the G8 group.

FIG. 6C: immunohistochemistry photograph (in color) of mouse brainslices from the G9 group.

FIG. 7 is a graph showing the statistical analyses of the volume of GFPtransduction in the substantia nigra (injection in the ventricle) inmouse brains from the G7 [Vehicle], G8 [AAV2-GFP], and G9 [mannoseAAV2-GFP] group, 48 days after intracerebroventricular injection. Barsrepresent the group mean; dots represent the individual animal values.The data were analyzed with one-way ANOVA.

FIG. 8A: immunohistochemistry photograph (in color) of mouse striatumslices from the G1 [Vehicle] group.

FIG. 8B: immunohistochemistry photograph (in color) of mouse striatumslices from the G2 [mannose AAV2] group.

FIG. 8C: immunohistochemistry photograph (in color) of mouse striatumslices from the G3 [AAV2-GFP] group.

FIG. 9A: immunohistochemistry photograph (in color) of mouse thalamusslices from the G1 [Vehicle] group.

FIG. 9B: immunohistochemistry photograph (in color) of mouse thalamusslices from the G2 [mannose AAV2-GFP] group.

FIG. 9C: immunohistochemistry photograph (in color) of mouse thalamusslices from the G3 [AAV2-GFP] group.

FIG. 10A: immunohistochemistry photograph (in color) of mouse substantianigra slices from the G1 [Vehicle] group.

FIG. 10B: immunohistochemistry photograph (in color) of mouse substantianigra slices from the G2 [mannoseAAV2-GFP] group.

FIG. 10C: immunohistochemistry photograph (in color) of mouse substantianigra slices from the G3 [AAV2-GFP] group.

FIG. 11A: immunohistochemistry photograph (in color) of mouse striatumslices from the G1 [Vehicle] group.

FIG. 11B: immunohistochemistry photograph (in color) of mouse striatumslices from the G2 [AAV2-GFP] group.

FIG. 11C: immunohistochemistry photograph (in color) of mouse striatumslices from the G3 [mannose AAV2-GFP] group.

FIG. 11D: immunohistochemistry photograph (in color) of mouse striatumslices from the G4 [galactose AAV2-GFP] group.

FIG. 11E: immunohistochemistry photograph (in color) of mouse striatumslices from the G5 [N-acetyGlucosamine AAV2-GFP] group.

FIG. 12A: immunohistochemistry photograph (in color) of mouse thalamusslices from the G1 [Vehicle] group.

FIG. 12B: immunohistochemistry photograph (in color) of mouse thalamusslices from the G2 [AAV2-GFP] group.

FIG. 12C: immunohistochemistry photograph (in color) of mouse thalamusslices from the G3 [mannose AAV2-GFP] group.

FIG. 12D: immunohistochemistry photograph (in color) of mouse thalamusslices from the G4 [galactose AAV2-GFP] group.

FIG. 12E: immunohistochemistry photograph (in color) of mouse thalamusslices from the G5 [NacetylGlucosamine AAV2] group.

FIG. 13A: immunohistochemistry photograph (in color) of mouse substantianigra slices from the G1 [Vehicle] group.

FIG. 13B: immunohistochemistry photograph (in color) of mouse substantianigra slices from the G2 [AAV2-GFP] group.

FIG. 13C: immunohistochemistry photograph (in color) of mouse substantianigra slices from the G3 [mannose AAV2-GFP] group.

FIG. 13D: immunohistochemistry photograph (in color) of mouse substantianigra slices from the G4 [galactose AAV2-GFP] group.

FIG. 13E: immunohistochemistry photograph (in color) of mouse substantianigra slices from the G5 [NacetylGlucosamine AAV2] group.

FIG. 14A: immunohistochemistry photograph (in color) of macaque striatumslices from the G2 [AAV2-GFP] group.

FIG. 14B: immunohistochemistry photograph (in color) of macaque striatumslices from the G3 [AAV5-GFP] group.

FIG. 14C: immunohistochemistry photograph (in color) of macaque striatumslices from the G4 [mannose AAV2-GFP] group.

FIG. 15A: immunohistochemistry photograph (in color) of macaquesubstantia nigra slices from the G2 [AAV2-GFP] group.

FIG. 15B: immunohistochemistry photograph (in color) of macaquesubstantia nigra slices from the G3 [AAV5-GFP] group.

FIG. 15C: immunohistochemistry photograph (in color) of macaquesubstantia nigra slices from the G4 [mannose AAV2-GFP] group.

FIG. 16A: Percentage of GFP transduction in the striatum. Bars representthe group mean; dots represent the individual animal values.

FIG. 16B: Percentage of GFP transduction in the substantia nigra. Barsrepresent the group mean; dots represent the individual animal values.

FIG. 17A: Schematic representation of the illustrating couplingreactions between a saccharide moiety and a AAV surface-exposed primaryamine (FIG. 17A: general case; 17B: illustrating example with a mannosemoiety).

EXAMPLE 1: EVALUATION OF THE TRANSDUCTION CAPABILITY OF TWO AAV VECTORSIN MOUSE BRAIN

The objective of the study was to investigate the potential of tworecombinant AAV (rAAV) vectors (“unmodified rAAV2” and “mannosylatedrAAV2”) to transduce large brain areas in mouse.

Materials

Animals

Twenty-four (24) male C57 BL/6 mice (Mus musculus), purchased fromJanvier Labs.

Test Items

“Unmodified rAAV2”, a recombinant AAV2 vector comprising an unmodifiedcapsid carrying an eGFP cDNA under control of a CAG promoter.

“Mannosylated rAAV2”, a recombinant AAV2 vector comprising a modifiedcapsid with surface-bound mannose residues, and carrying an eGFP cDNAunder control of a CAG promoter. Mannose residues were covalently boundto primary amines of lysine residues exposed at the surface of the AAV2capsid. FIG. 1 provides a visual representation of mannosylated rAAV2.

“Vehicle”, a lactate Ringer's solution (LRS), as negative control.

Methods

Test Items

Mannosylated rAAV2 was produced as previously described in Internationalpatent publication WO2017212019 and illustrated in FIG. 1. Briefly,unmodified rAAV2 were mixed in Tris buffer pH 9.3 withisothiocyanate-linker-mannose molecules, and incubated during 4 hours at20° C. The mix was then dialyzed against buffered saline sterilesolution (BSSS)+0.001% Pluronic® F68 remove free molecules that did notbind to the AAV capsid.

Study Design

Twenty-four (24) mice underwent stereotactic surgery and were injectedunilaterally with the test items into the right striatum, the rightthalamus or the right lateral ventricle.

The animals were randomly assigned to 9 groups, names G1 to G9,according to Table 1.

TABLE 1 Treatment schedule. Group n Treatment Target G1 2 Vehicle Rightstriatum G2 3 Unmodified rAAV2 Right striatum G3 3 Mannosylated rAAV2Right striatum G4  1* Vehicle Right thalamus G5 3 Unmodified rAAV2 Rightthalamus G6 3 Mannosylated rAAV2 Right thalamus G7 2 Vehicle Rightlateral ventricle G8 3 Unmodified rAAV2 Right lateral ventricle G9 3Mannosylated rAAV2 Right lateral ventricle *In group G4, one mouse wasfound dead before termination of the experiment.

Surgical Procedures

Buprenorphine (0.1 mg/kg; 10 mL/kg, s.c.) was given as an analgesicbefore and after surgery. The animal was placed in an anesthetic chambersupplied with a continuous flow of oxygen (1.5 L/min) and 3% isoflurane.Following loss of consciousness, the animal was placed in a stereotacticframe (Kopf) and its head was fixed into position using ear bars. Theskin of the skull was incised.

Each mouse received unilateral injections (2 for striatum, 2 forthalamus, 1 for ventricle) of one of the test items using a glasspipette, at the coordinates described in Table 2. For an atlas of themouse brain, see Paxinos & Franklin, 2019. The mouse brain instereotaxic coordinates (5^(th) ed.). San Diego, Calif.: ElsevierScience Publishing Co Inc.

TABLE 2 Injection coordinates. AP: anterior-posterior; ML:medial-lateral; DV: dorsal-ventral. AP ML DV Volume/target Titer/targetTarget (mm) (mm) (mm) (μL) (vg/mL) Right striatum +1.0 2.1 −2.6 0.5 5.5× 10¹¹ +0.3 2.3 −2.6 0.5 5.5 × 10¹¹ Right thalamus −1.8 1.8 −3.4 0.5 5.5× 10¹¹ −2.5 1.8 −3.4 0.5 5.5 × 10¹¹ Right ventricle −0.5 1.0 −2.4 4  3.6 × 10¹¹

Animals were allowed to recover for 48 days before euthanasia wascarried out.

Ex Vivo Analysis

Euthanasia and Tissue Processing

At the end of the in vivo phase, animals were euthanized and tissue werecollected. Euthanasia was performed in accordance with accepted EuropeanVeterinary Medical Association guidelines.

At termination, the brain of each animal was quickly removed and fixedin paraformaldehyde (PFA; 4%). After 3 days, the tissues werecryoprotected in 20% sucrose solution (in 0.1 M PBS) at 4° C. overnightand then frozen.

The whole brain was cut into 50 μm thick coronal sections using acryostat. Free-floating sections were placed in PBS azide and stored at4° C.

GFP Immunohistochemistry

Definition of the percentage of transduced brain volume in the regionsof interest was made based upon GFP immunohistochemistry. One in everyfour sections was used for immunohistochemistry.

Tissue sections were taken from the refrigerator and left to adjust toroom temperature. After thorough rinsing with PBS, endogenous peroxidasewas inhibited with peroxidase-blocking solution (Dako, 52023) for 10minutes.

After thorough rinsing with PBS, non-specific labelling was prevented byblocking antigenic sites with PBS containing 2% BSA, 0.3% Triton X-100and 0.01% thimerosal for 30 minutes.

Sections were incubated overnight in primary antibody (rabbit anti-GFP,polyclonal antibody, Ab3080, Merck) diluted at 1/1000 in PBS containing0.2% BSA, 0.3% Triton X-100 and 0.01% thimerosal.

After thorough rinsing with PBS, sections were incubated for 30 minuteswith Dako Envision labelled polymer HRP anti-rabbit (Dako, K4011).

After thorough rinsing with PBS, revelation was obtained with Dako DAB.After approximately 30 seconds, revelation was stopped with several PBSwashes.

Sections were then mounted onto slides and counterstained with a Nisslstain. The slides were digitized using a PannoramicScan II (3DHISTECH,Hungary) at a ×20 magnification with an extended mode in which 5-layerfocus is automatically acquired and then flatten.

The striatum, the thalamus, and the substantia nigra were drawn usingthe MERCATOR software (Mercator, Explora Nova, La Rochelle, France) on10, 10 and 6 sections, respectively.

Using the whole transduced area (with artifacts excluded), the surfaceof GFP staining was obtained using a threshold detection method. Thevolume was calculated using the formula

V=ΣS td

where “ΣS” is the sum of surface areas; “t” is the average sectionthickness; and “d” is the number of slices between two consecutivesanalyzed sections measured.

The percentage of transduced brain volume in the regions of interest wasthen calculated.

Data Analysis

A one-way ANOVA was performed to assess the difference between thetreatment groups followed by Tukey's multiple comparison (Graphpad Prismversion 8.0.2).

Results

Injection in the Striatum

Immunohistochemically stained brain slices of mouse from the G1, G2 andG3 group are shown in FIG. 2A, FIG. 2B and FIG. 2C, respectively. Thepercentage of GFP staining area is given in Table 3.

TABLE 3 GFP staining area after intrastriatal injection. Location GroupG1 Group G2 Group G3 Striatum 0% 12.90% 45.44% Substantia nigra 0% 9.98% 50.21%

Statistical analyses of the GFP transduction in the striatum (FIG. 3A)and substantia nigra (FIG. 3B), 48 days after intrastriatal injection,are summarized in Table 4.

TABLE 4 GFP transduction after intrastriatal injection. Location One-wayANOVA p value Striatum F (2, 5) = 48.82 0.0005 Substantia nigra F (2, 5)= 271.9 <0.0001 

The significant differences between treatment groups following Tukey'smultiple comparison test for % of GFP transduction in the striatum aresummarized in Table 5.

TABLE 5 Difference between treatment groups after intrastriatalinjection. Tukey’s multiple comparison p value G1 vs G3 0.0006 G2 vs G30.0017

The significant differences between treatment groups following Tukey'smultiple comparison test for % of GFP transduction in the substantianigra are summarized in Table 6.

TABLE 6 Difference between treatment groups after intrastriatalinjection. Tukey’s multiple comparison p value G1 vs G2 0.0203 G1 vs G3<0.0001  G2 vs G3 <0.0001 

Injection in the Thalamus

Immunohistochemically stained brain slices of mouse from the G4, G5 andG6 group are shown in FIG. 4A, FIG. 4B and FIG. 4C, respectively. Thepercentage of GFP staining area is given in Table 7.

TABLE 7 GFP staining area after intrathalamic injection. Location GroupG4 Group G5 Group G6 Thalamus 0% 8.67% 37.85% Substantia nigra 0%   0% 1.67%

Statistical analyses of the GFP transduction in the thalamus (FIG. 5A)and substantia nigra (FIG. 5B), 48 days after intrathalamic injection,are summarized in Table 8.

TABLE 8 GFP transduction after intrathalamic injection. Location One-wayANOVA p value Thalamus F (2, 4) = 744.4 <0.0001  Substantia nigra F (2,4) = 1.756 0.2835

The significant differences between treatment groups following Tukey'smultiple comparison test for % of GFP transduction in the thalamus aresummarized in Table 9.

TABLE 9 Difference between treatment groups after intrathalamicinjection. Tukey’s multiple comparison p value G4 vs G5 0.005 G4 vs G6<0.0001 G5 vs G6 <0.0001

Injection in the Ventricle

Immunohistochemically stained brain slices of mouse from the G7, G8 andG9 group are shown in FIG. 6A, FIG. 6B and FIG. 6C, respectively. Thepercentage of GFP staining area is given in Table 10.

TABLE 10 GFP staining area after intrathalamic injection. Location GroupG7 Group G8 Group G9 Substantia nigra 0% 0.01% 0.22%

Statistical analyses of the GFP transduction in the substantia nigra(FIG. 7), 48 days after intracerebroventricular injection, aresummarized in Table 11.

TABLE 11 GFP transduction after intracerebroventricular injection.Location One-way ANOVA p value Substantia nigra F (2, 5) = 0.9057 0.4617

No significant differences between treatment groups in the % of GFPtransduction were observed.

Conclusion

The objective of the study was to investigate the potential of two AAVvectors (“unmodified rAAV2” and “mannosylated rAAV2”) to transduce largebrain areas in mouse.

Both AAV vectors drove the expression of GFP and the surface of the GFPstaining in specific brain areas was used to assess the capability ofeach vector to transduce brain cells.

When the injection was made in the striatum, the percentage of GFPstaining in the striatum was 12.90% for unmodified rAAV2 and 45.44% formannosylated rAAV2; in the substantia nigra, it was 9.98% for unmodifiedrAAV2 and 50.21% for the mannosylated rAAV2.

When the injection was made in the thalamus, the percentage of GFP inthe thalamus was 8.67% for the unmodified rAAV2 and 37.85% for themannosylated rAAV2; in the substantia nigra, it was 0% for theunmodified rAAV2 and 1.67% for the mannosylated rAAV2.

When the injection was made in the ventricle, the percentage of GFP inthe substantia nigra was of 0.01% for the unmodified rAAV2 and 0.22% forthe mannosylated rAAV2.

The mannosylated rAAV2 achieved a larger coverage of expression thanunmodified rAAV2, when administered in the brain parenchyma (striatum orthalamus). Anterograde as well as retrograde transportation of themannosylated rAAV2 is observed.

Besides the actual measurements in dedicated brain areas, the generalaspect is clearly in favor of mannosylated rAAV2 since a singleadministration in the brain parenchyma (striatum or thalamus) led to awhole hemisphere transduction. In particular, immunohistochemicalanalyses showed that GFP expression is also located in the cortexfollowing both intrastriatal and intrathalamic injections.

EXAMPLE 2: EVALUATION OF THE TRANSDUCTION CAPABILITY OF TWO AAV VECTORSIN MOUSE CISTERNA MAGNA

The objective of this study was to compare brain distribution of GFPfollowing injection of a modified recombinant AAV2-GFP (also referred toas Mannose-AAV2-GFP) vs. unmodified AAV2-GFP via the cisterna magnaroute in mice. The extent of labelling, as a proxy of the area oftransduction, was performed by GFP staining on one series of section ofstriatum, thalamus, substantia nigra (SN) for all groups of animals.

Materials

Animals

Eight (8) male C57 BL/6 mice (Mus musculus) were purchased from JanvierLabs.

Test Items

“Mannose-AAV2-GFP” is a recombinant AAV2 vector comprising a modifiedcapsid with surface-bound mannose residues, and carrying an eGFP cDNAunder control of a CAG promoter. Mannose residues were covalently boundto primary amines of lysine residues exposed at the surface of the AAV2capsid, as described in Example 1.

“Vehicle” is buffered saline sterile solution (BSSS)+0.001% Pluronic®F68, as a negative control.

Methods

Test Items

Mannosylated rAAV2s were produced as previously described inInternational patent publication WO2017212019 and illustrated in FIG. 1.Briefly, unmodified rAAV2 were mixed in Tris buffer pH 9.3 withisothiocyanate-linker-mannose molecules, and incubated during 4 hours at20° C. The mix was then dialyzed against buffered saline sterilesolution (BSSS)+0.001% Pluronic® F68 to remove free molecules that didnot bind to the AAV capsid.

Study Design

Eight (8) mice underwent stereotactic surgery and were injectedunilaterally with the test items into the cisterna magna.

The animals were randomly assigned to 3 groups, names G1 to G3,according to Table 12.

TABLE 12 Treatment schedule. Group n Treatment Target G1 2 VehicleCisterna magna G2 3 Mannose-AAV2-GFP Cisterna magna G3 3 AAV2-GFPCisterna magna

Surgical Procedure

Buprenorphine (0.1 mg/kg; 10 mL/kg, s.c.) was given as an analgesicbefore and after surgery. The animal was placed in an anesthetic chambersupplied with a continuous flow of oxygen (1.5 L/min) and 3% isoflurane.Following loss of consciousness, the animal was placed in a stereotacticframe (Kopf) and its head was fixed into position using ear bars. Theskin of the skull was incised.

Each mouse received a cisterna magna injection of 1.3 10E9 vg/brain (orvehicle).

Ex Vivo Analysis

Euthanasia and Tissue Processing

At the end of the in vivo phase (42 days following injection), animalswere euthanized and tissue were collected, as described in Example 1.

GFP Immunohistochemistry

GFP immunohistochemistry was performed as described in Example 1.

Results

GFP staining in the striatum Representative immunohistochemicallystained striatum slices of mouse from the G1, G2 and G3 group are shownin FIG. 8A, FIG. 8B and FIG. 8C respectively.

GFP Staining in the Thalamus

Representative immunohistochemically stained thalamus slices of mousefrom the G1, G2 and G3 group are shown in FIG. 9A, FIG. 9B and FIG. 9Crespectively.

GFP Staining in the Substantia Nigra

Representative immunohistochemically stained substantia nigra slices ofmouse from the G1, G2 and G3 group are shown in FIG. 10A, FIG. 10B andFIG. 10C respectively.

Conclusion

The objective of the study was to investigate the potential of two AAVvectors (“unmodified AAV2-GFP” and “Mannose-AAV2-GFP”) to transducelarge brain areas in mouse.

Neither the striatum nor the hippocampus appears to be transduced aftercisterna magna injection of both AAV2 vectors.

In contrast, each AAV vectors drove the expression of GFP in thethalamus and the substantia nigra but to a different extent.

However, the mannosylated rAAV2 appears to induce a stronger GPFexpression than the unmodified rAAV2 in the thalamus and the substantianigra. Moreover, the mannosylated rAAV2 achieved a greater bilateralcoverage of expression of thalamic nuclei and the substantia nigra thanthe unmodified AVV2, when administered through the cisterna magna. Thus,a single administration of the mannosylated rAAV2 in the cisterna magnaled to a bilateral thalamus and substantia nigra transduction.

EXAMPLE 3: EVALUATION OF THE TRANSDUCTION CAPABILITY OF THREE MODIFIEDAAV VECTORS IN MOUSE RIGHT STRIATUM

The objective of this study was to compare brain distribution of GFPfollowing injection of 3 modified rAAV2-GFP (Mannose-AAV2-GFP,Galactose-AAV2-GFP, a N-AcetylGlucosamine-AAV2-GFP) vs. unmodifiedAAV2-GFP via the intrastriatal route in mice. The extent of labelling,as a proxy of the area of transduction, was performed by GFP staining onone series of section of striatum, thalamus, substantia nigra (SN) forall groups of animals.

Materials

Animals

Fourteen (14) male C57 BL/6 mice (Mus musculus) were purchased fromJanvier Labs.

Test Items

“Modified rAAV2-GFP” is a recombinant AAV2 vector comprising a modifiedcapsid with surface-bound saccharide residues (either mannose, galactoseor N-acetyl-glucosamine), and carrying an eGFP cDNA under control of aCAG promoter. Mannose, galactose and N-acetyl-glucosamine residues werecovalently bound to primary amines of lysine residues exposed at thesurface of the AAV2 capsid, as described in Example 1.

“Vehicle” is DPBS Ca2+, Mg2+, 0.001% Pluronic® F68, as a negativecontrol.

Methods

Test Items

Modified rAAV2s were produced as previously described in Internationalpatent publication WO2017212019 and illustrated in FIG. 1. Briefly,unmodified rAAV2 were mixed in Tris buffer pH 9.3 withisothiocyanate-linker-saccharide molecules, and incubated during 4 hoursat 20° C. The mix was then buffer-exchanged against DPBS, Ca2+, Mg2+supplemented with 0.001% Pluronic® F68 to remove free molecules that didnot bind to the AAV capsid.

Study Design

Fourteen (14) mice underwent stereotactic surgery and were injectedunilaterally with the test items into the right striatum.

The animals were randomly assigned to 5 groups, names G1 to G5,according to Table 13.

TABLE 13 Treatment schedule. Group n Treatment Target G1 2 Vehicle Rightstriatum G2 3 AAV2-GFP Right striatum G3 3 Mannose-AAV2-GFP Rightstriatum G4 3 Galactose-AAV2-GFP Right striatum G5 3N-acetyl-glucosamine-AAV2-GFP Right striatum

Surgical Procedure

Buprenorphine (0.1 mg/kg; 10 mL/kg, s.c.) was given as an analgesicbefore and after surgery. The animal was placed in an anesthetic chambersupplied with a continuous flow of oxygen (1.5 L/min) and 3% isoflurane.Following loss of consciousness, the animal was placed in a stereotacticframe (Kopf) and its head was fixed into position using ear bars. Theskin of the skull was incised.

Each mouse received two unilateral injections into the right striatum ofone of test items (or vehicle), corresponding to a total dose of 5.510E8 vg/brain of the test item. This was performed using a glass pipettecoupled to a picosprizer, at the coordinates of Table 14.

TABLE 14 Injection coordinates. AP: anterior-posterior; ML:medial-lateral; DV: dorsal-ventral. AP ML DV Volume/target Target (mm)(mm) (mm) (μL) Right striatum +1.0 2.1 −2.6 0.5 +0.3 2.3 −2.6 0.5

Ex Vivo Analysis

Euthanasia and Tissue Processing

At the end of the in vivo phase (6 weeks following injection), animalswere euthanized and tissue were collected, as described in Example 1.

GFP Immunohistochemistry

GFP immunohistochemistry was performed as described in Example 1.

Results

GFP Staining in the Right Striatum

Representative immunohistochemically stained striatum slices of mousefrom the G1, G2, G3, G4 and G5 group are shown in FIG. 11A, FIG. 11B,FIG. 11C, FIG. 11D and FIG. 11E respectively.

GFP Staining in the Thalamus

Representative immunohistochemically stained thalamus slices of mousefrom the G1, G2, G3, G4 and G5 group are shown in FIG. 12A, FIG. 12B,FIG. 12C, FIG. 12D and FIG. 12E respectively.

GFP Staining in the Substantia Nigra

Immunohistochemically stained substantia nigra slices of mouse from theG1, G2, G3, G4 and G5 group are shown in FIG. 13A, FIG. 13B, FIG. 13C,FIG. 13D and FIG. 13E respectively.

Conclusion

The objective of the study was to investigate the potential of threemodified AAV vectors compared to an unmodified AAV2 vector to transducelarge brain areas in mouse:

-   -   unmodified AAV2-GFP    -   Mannose-AAV2-GFP    -   Galactose-AAV2-GFP    -   N-acetyl-glucosamine-AAV2-GFP

Every AAV vectors drove the expression of GFP.

Animals that were injected into the striatum were stained for back toback comparison. The parent AAV2-GFP leads to ipsilateral GFP stainingin the striatum, thalamus, and substantia nigra.

The other three modified vectors presented a similar pattern ofimmunostaining in the striatum, thalamus, and substantia nigra.

Parietal cortices and hippocampus area appeared to be widely transducedwith the three modified rAAV2s.

Although some cortical areas, mostly parietal, might present differencesbetween vectors, both Mannose-AAV2-GFP and N-acetylglucosamine-AAV2-GFPinjected animals presented a strong immunostaining in the ispislateraland contralateral hippocampus. N-acetylglucosamine-AAV2-GFP injectioninduced a stronger GFP staining in the dentate gyrus compared toMannose-AAV2-GFP injection.

EXAMPLE 4: EVALUATION OF THE TRANSFECTION CAPABILITY OF SEVERAL AAVVECTORS IN MACAQUE MONKEY STRIATUM

The objective of this proposal was to investigate the potential of threeviral vectors, an unmodified AAV2-GFP, an unmodified AAV5-GFP and amodified recombinant AAV2-GFP (also referred to as Mannose-AAV2-GFP), totransfect large brain areas in the macaque monkey.

Materials

Animals

Seven (7) male Cynomolgus monkeys (Macaca fascicularis) were purchasedfrom BioPrim, France.

Test Items

“modified rAAV2-GFP” is a recombinant AAV2 vector comprising a modifiedcapsid with surface-bound mannose residues wherein said residues werecovalently bound to primary amines of lysine residues exposed at thesurface of the AAV2 capsid, and carrying an eGFP cDNA under control of aCAG promoter.

“Vehicle” is Buffered Saline Sterile Solution (BSSS)+0.001% Pluronic®F68, as a Negative control.

Methods

Test Items

Mannosylated rAAV2s were produced as previously described inInternational patent publication WO2017212019 and illustrated in FIG. 1.Briefly, unmodified rAAV2 were mixed in Tris buffer pH 9.3 withisothiocyanate-linker-mannose molecules, and incubated during 4 hours at20° C. The mix was then dialyzed against buffered saline sterilesolution (BSSS)+0.001% Pluronic® F68 to remove free molecules that didnot bind to the AAV capsid.

Study Design

Seven (7) macaques underwent stereotactic surgery and receivesunilateral injections into the right striatum by stereotactic surgery.

The animals are randomly assigned to 4 groups, names 1 to 4, accordingto Table 15.

TABLE 15 Treatment schedule. Group n Treatment Target 1 1 VehicleStriatum 2 2 AAV2-GFP Striatum 3 2 AAV5-GFP Striatum 4 2Mannose-AAV2-GFP Striatum

Preoperative Procedure

Anesthesia and Antibiotic and Analgesic Therapy

On the day prior to surgery animals were given Duphamox at 15 mg/kgsubcutaneously (s.c.) for infection prophylaxis.

On the day of surgery, each animal was given atropine SO4 at 0.04 mg/kg,intra-muscularly (i.m.) prior to preparation for surgery. Thenon-steroidal anti-inflammatory drug Ketophen was then given at 2 mg/kgsubcutaneously (s.c.). At least 10 minutes later, each animal wasinitially anaesthetized with Ketamine HCl at 10 mg/kg, i.m.

Xylocaine cream was then be applied topically as an anestheticlubricant. The animal was then intubated and maintained in anesthesiawith isoflurane inhalant anesthetic delivered through a volume-regulatedrespirator. The heart rate and oxygen saturation were monitored andrecorded at intervals of at least 30 minutes throughout surgery. Atemperature probe was placed rectally to allow for monitoring of corebody temperature at intervals of at least 30 minutes throughout surgery.Animals were placed on a heating pad with a second pad placed on top ofthe animals if required as indicated by a drop in the animal's core bodytemperature.

Surgical Preparation

An ophthalmic ointment was administered to each eye (Liposic ophthalmicgel). The hair was clipped from the cranium and cranio-dorsal portion ofthe neck and sides.

Each animal was positioned for surgery in a stereotactic apparatus.

The surgical site was prepared for aseptic surgery by initially wipingthe area with sponges soaked in 70% isopropyl alcohol scrub, which wasallowed to dry, followed by application of DuraPrep™ (or similarsolution), which will also be allowed to dry. The animals wereappropriately draped for strict aseptic surgery.

Surgical Procedures

Location of Injections Sites

As individual macaques differ greatly with regard to specificintracerebral sites, the standard Horsley-Clarke stereotactic techniquehas been improved by using sagittal and frontal ventriculography tolocate with accuracy the borders of the third ventricles and the edgesof the anterior and posterior commissures.

After making a small craniotomy, without damaging the dura matter, aventriculographic cannula mounted on a glass syringe was introduced intothe anterior horn of the lateral ventricle and a contrast medium(Omnipaque, Nycomed, Norway) injected.

A stereotactic atlas was used for precise adjustment before insertioninto the skull. The precise position of the anterior commissure wasdetermined from ventriculography. The actual position of the left andright putamen was defined by combining the ventriculography-definedposition of the anterior commissure and a stereotactic population-basedhistorical atlas of the basal ganglia. Placement of the infusion cannulafor delivery of the test item was then performed as describedhereinbelow.

Test Item Administration

The area of the craniotomy was cleaned with sterile saline. Each animalthen received unilateral injections of test items, corresponding to atotal dose of 7.7 10E10 vg/brain of the test item.

The injections were made at two different depths, along three trackswithin the putamen at Anterior Commissure (AC): AC+1, AC−2 and AC−5 mm.

The injections were made using a Hamilton 1701N syringe (100 μl, 30Ga/51mm/PST3) coupled to an automatic injector UMP-3 linked to Micro-4controller (WPI), at a rate of 3 μl/min, with a total volume injectedper animal of 90 μl.

The needle was left in place for 1 min after the deepest deposit of eachtrack and 5 min after the second deposit of each track before beingslowly withdrawn from the brain.

Once all injections had been completed the wound was closed in layerswith a continuous pattern of absorbable suture material. The skin wasclosed with an appropriate size of absorbable suture material, placed ina subcuticular pattern. The animal was then allowed to recover fromanesthesia.

Postoperative Monitoring

Checks on the condition of the animals were performed twice daily (a.m.and p.m.). Observers particularly focused on limb movements, offeringpieces of fruits or sweets to the animals for enabling proper assessmentof quality of limb movements.

The surgical incisions were observed for signs of infection,inflammation, and general integrity at least once daily (until incisionswere healed).

Animals were assessed daily according to established humane end-pointcriteria. Appropriate veterinary support was given if necessary. Anyanimal showing signs of severe pain or distress, which is likely toendure, was to be promptly euthanized.

Ex Vivo Analysis

Euthanasia and Tissue Processing

On day 56 following injections, the animals were humanely euthanised bybarbiturate overdose in accordance with European Veterinary MedicalAssociation guidelines and then perfused with saline containing heparinfollowed by a 4% paraformaldehyde solution.

A comprehensive necropsy was performed and the following organs wereremoved: brain, heart, kidneys, liver, lungs, mesenteric lymph nodes,spleen, spinal cord (with a focus on dorsal root ganglion). A necropsyreport for each individual was done.

The brain was fixed by immersion in paraformaldehyde (PFA: 4%). Thetissue was then cryoprotected in 20% sucrose solution (in 0.1 M PBS) at4° C. and then frozen. 50 μm sections (in coronal orientation for onehemisphere of the brain) was cut using a cryostat. Free-floatingsections will be placed in cryoprotectant solution and stored at −20° C.

GFP Immunohistochemistry

GFP immunohistochemistry was performed as described in Example 1.

GFAP-NeuN— GFP Double Fluorescence staining

The cell tropism in the striatum, substantia nigra and globus palliduswere defined using double immunostaining for GFP and neuronal (NeuN),astroglial (GFAP/S100), oligodendroglia) (Olig2) or microglial (Iba1)markers.

GFP and NeuN/GFAP/Olig2/Iba1 immunohistochemistry were performedtogether in one section per structure of interest per animal.

After thorough rinsing with PBS, non-specific labelling was prevented byblocking antigenic sites in PBS containing 2% BSA, 0.3% triton X-100 and0.01% thimerosal, for 30 minutes.

Sections were then incubated overnight at room temperature in primaryantibodies mix (anti-Iba1 Abcam ab5076 1/1000; anti-GFAP-S10 DakoZ0334-Z0311, 1/1000 and 1/2000; anti-Olig2 EPR2676 Abcam, 1/100;anti-NeuN MAB377 Merck, 1/500) in PBS containing 0.2% BSA, 0.3% tritonX-100 and 0.01% thimerosal.

On the next day, sections were rinsed with PBS and incubated for 30minutes incubation with antibody, conjugated with a Dylight®488fluorophore diluted at 1:500 in PBS.

After thorough rinsing with PBS between each step, one antibody wasrevealed with polymer-HRP anti-rabbit (Dako EnVision+™ Kit, K4011) for30 minutes followed by a 30 minutes incubation with an anti-HRP antibodyconjugated with a Dylight®549 fluorophore diluted at 1:1000 in PBS.

After thorough rinsing with PBS, nuclear Hoechst staining was performedon sections (Hoechst solution diluted at 1:5000) for 30s and stoppedwith several PBS washes.

Sections were then mounted onto gelatin-coated slides, cover-slipped inaqueous Fluoromount™ mounting media and stored at 4° C. until analysis.

Fluorescence images were acquired for both staining with the sameexposure parameters among all sections on an Olympus epifluorescencemicroscope (Olympus BX63) coupled with a CCD camera (Hamamatsu ORCAFlash 4.0LT). Three fields of view were acquired at ×40 magnificationfor each area and section. 16 bites image files were saved and treatedin ImageJ software.

Histopathology

In addition to the macroscopic analysis of brain, heart, kidneys, liver,lungs, mesenteric lymph nodes, spleen, spinal cord (with a focus ondorsal root ganglion), these tissues were subject to hispathologicalanalysis. The organs/tissues were sampled and put in cassettes forparaffin-embedding. Three blocks per organ were prepared and at least 4sections per block were examined.

Results

GFP Staining in the Striatum

Representative immunohistochemically stained striatum slices of macaquesfrom the G2, G3 and G4 groups are shown in FIG. 14A, FIG. 14B and FIG.14C respectively.

GFP Staining in the Substantia Nigra

Representative immunohistochemically stained substantia nigra slices ofmacaques from the G2, G3 and G4 groups are shown in FIG. 15A, FIG. 15Band FIG. 15C respectively.

The percentages of GFP transduction in the striatum and in thesubstantia nigra, 56 days after intrastriatal injection, arerespectively shown on FIG. 16A and FIG. 16B.

Cellular Tropism

External Globus Pallidus (GPe) and internal Globus Pallidus (GPi) slicesof macaques from the G1, G2, G3 and G4 groups are immunofluorescentlyco-stained for:

-   -   Iba1 and GFP    -   GFAP/S100 and GFP    -   Olig2 and GFP    -   NeuN and GFP.

Iba1 antibody allows staining of microglia, NeuN antibody allowsstaining of neuronal cells, GFAP/S100 antibody allows staining ofastroglial cells and Olig2 antibody allows staining of oligodendroglialcells.

Conclusion

Seven macaque monkeys were used in this study and assigned to 4 groups.Vectors or vehicle were administered within the putamen part of thestriatum. The vector Mannose-AAV2-GFP transduced over 80% of thestriatum and over 60% of the substantia nigra, while unmodified AAV2-GFPand AAV5-GFP both only achieved under 50% of the striatum and 40% of thesubstantia nigra.

Histopathology did not show any sign of toxicity in major organs,including dorsal root ganglions (DRG).

Double fluorescence staining was performed for GFP on one hand (index oftransduction) and for a phenotypic cellular marker (NeuN for neuron,GFAP-S100 for astrocytes, Olig2 for oligodendrocytes and Iba1 formicroglial cells).

In the striatum, all three vectors were expressed in medium spinyneurons, while no obvious GFP expression was detected in astrocytes,oligodendrocytes or microglial cells (data not shown).

In the substantia nigra, all three vectors were expressed in terminals,with a distinctive fibrillar pattern, and none showed a cell bodyexpression of GFP (data not shown), i.e. no obvious GFP expression wasdetected in neurons, astrocytes, oligodendrocytes or microglial cells ofthe substantia nigra. Those fibres present into the substantia nigra aremost likely the GABAergic projections of the medium spiny neurons thatproject from the striatum to the substantia nigra (neuronal cytoplasmicstaining in the striatum, fibres in the substantia nigra).

The pallidal complex may be divided into GPe and GPi. While the GPeappears to be crossed by a huge GFP-positive fibres network with nocellular co-staining (whatever the cell type), the GPi, besides abeautiful fibre network consistent with the striatofugal neurons mightpresent some neuronal transduction by the three vectors.

Altogether these results show that Mannose-AAV2-GFP transduced striatalmedium spiny neurons with a great efficiency, largely superior to thetwo other vectors. The cellular tropism in the analyzed brain regionswas comparable between the 3 vectors.

The observed transduction patterns suggest that Mannose-AAV2-GFP holds atherapeutic profile of great interest for gene therapy targeting thestriatum and the substantia nigra.

Until today, all gene therapy approaches for neurological disorderstested in human have not reached a clinical significance, mainly becauseof a lack of solid expression at the target site and/or at the afferencelevel.

The inventors have surprisingly shown that their modified AAV vectorsare capable of effectively transducing certain areas of the brain,including the striatum, the thalamus, the substantia nigra, the parietalcortices, the hippocampus and the globus pallidus. Thus, these modifiedAAV vectors are of great interest for targeting these areas, and/or fortreating diseases affecting these areas.

1. A modified adeno-associated virus (AAV) vector for use in theprevention or treatment of a central nervous system (CNS) disease,wherein said modified AAV vector comprises at least one surface-boundsaccharide, wherein said modified AAV vector is to be administereddirectly to the CNS, and wherein said modified AAV vector is not to beadministered intracerebroventricularly.
 2. The modified AAV vector foruse according to claim 1, wherein said CNS disease is a CNS infectiousdisease, a CNS degenerative disease, a CNS auto-immune disease, a CNStumor disease, a cerebrovascular disease, a CNS injury or a CNSstructural defect.
 3. The modified AAV vector for use according to claim1 or 2, wherein said modified AAV vector is to be administeredintrastriatally, intrathalamically or intracisternally.
 4. The modifiedAAV vector for use according to any one of claims 1 to 3, wherein saidmodified AAV vector is selected from AAV1, AAV2, AAV3, AAV4, AAV5, AAV6,AAV7, AAV8, AAV9, AAV10, AAV11 and AAV12; or pseudotypes, chimeras, andvariants thereof
 5. The modified AAV vector for use according to any oneof claims 1 to 4, wherein said modified AAV vector is an AAV2 vector. 6.The modified AAV vector for use according to any one of claims 1 to 5,wherein the surface-bound saccharide is selected from the groupcomprising monosaccharides, oligosaccharides and polysaccharides.
 7. Themodified AAV vector for use according to any one of claims 1 to 6,wherein the surface-bound saccharide is a hexose, preferably a mannose,galactose or N-acetylglucosamine.
 8. The modified AAV vector for useaccording to any one of claims 1 to 7, wherein the surface-boundsaccharide is covalently bound to at least one capsid protein of the AAVvector, preferably to at least one surface-exposed amino acid residue ofat least one capsid protein of the AAV vector.
 9. The modified AAVvector for use according to any one of claims 1 to 8, wherein thesurface-bound saccharide is covalently bound through a linker.
 10. Themodified AAV vector for use according to any one of claims 1 to 9,wherein said modified AAV vector comprises at least one transgene. 11.The modified AAV vector for use according to claim 10, wherein said atleast one transgene comprises a cDNA, or a fragment thereof, from a geneselected from the group comprising 3R tau, 4R tau, AARS, ABCD1, ACOX1,ADGRV1, ADRA2B, AGA, AGER, ALDH7A1, ALG13, ALS2, ANG, ANXA11, APP,ARHGEF9, ARSA, ARSB, ARV1, ASAH1, ASPA, ATN1, ATP10A, ATP13A2, ATXN1,ATXN2, ATXN3, BAX, BCL-2, BDNF, BICD2, C9orf72, CACNA1A, CACNA1H,CACNB4, CASR, CCNF, CDKL5, CERS1, CFAP410, CHCHD10, CHD2, CHMP2B,CHRNA2, CHRNA4, CHRNA7, CHRNB2, CLCN2a, CLN1, CLN2, CLN3, CLN5, CLN6,CLN8, CNTN2, CPA6, CSTB, CTNS, CTSA, CTSD, DAO, DCTN1, DEPDC5, DMD,DNAK32, DNM1, DOCK7, DRD2, DYNC1H1, EEF1A2, EFHC1, EGLN1, EPHA4, EPM2A,ERBB4, FGF12, FIG4, FRRS1L, FTL, FUCA1, FUS, FXN, GAA, GABRA1, GABRB1,GABRB3, GABRD, GABRG2, GAL, GALC, GALNS, GBA, GFAP, GLA, GLB1, GLE1,GLT8D1, GNAO1, GNS, GOSR2, GPR98, GRIA1, GRIA2, GRIK1, GRIN1, GRIN2A,GRIN2B, GRIN2D, GSTM1, GUF1, GUSB, HCN1, HGSNAT, HNRNPA1, HTT, HYAL1,IDS, IDUA, IGHMBP2, IL-1, IT15, ITPA, JPH3, KCNA2, KCNB1, KCNC1, KCNMA1,KCNQ2, KCNQ3, KCNT1, KCTD7, LAL, LAMP2, LGI1, LMNB2, LRRK2, MAN2B1,MAN2B2, MAN2C1, MANBA, MATR3, MBD5, MFSD8, NAGA, NAGLU, NECAP1, NEFH,NEK1, NEU1, NHLRC1, NPC1, NPC2, NR4A2, NTRK2, OCA2, OPTN, PARK2, PARK7,PCDH19, PEX1, PEX2, PEX3, PEX5, PEX6, PEX10, PEX11B, PEX12, PEX13,PEX14, PEX16, PEX19, PEX26, PFN1, PINK1, PLCB1, PNPO, PON1, PON2, PON3,PPARGC1A, PRDM8, PRICKLE1, PRKN, PRNP, PRPH, PRRT2, PSAP, S106β, SCARB2,SCN1A, SCN1B, SCN2A, SCN8A, SCN9A, SCN9Ab, SETX, SGSH, SIGMAR1, SIK1,SKP1, SLC1A1, SLC1A2, SLC2A1, SLC6A1, SLC9A6, SLC12A5, SLC13A5,SLC25A12, SLC25A22, SLCA17A5, SMN1, SMPD1, SNCA, SNRPN, SOD1, SPG11,SPTAN1, SQSTM1, ST3GAL3, ST3GAL5, STX1B, STXBP1, SYP, SYT1, SZT2, TAF15,TARDBP, TBC1D24, TBCE, TBK1, TBP, TITF-1, TREM2, UBA5, UBE1, UBE3A,UBQLN2, UCH-L1, UNC13A, VAPB, VCP, VPS35, WWOX, and XBP1.
 12. Themodified AAV vector for use according to any one of claims 2 to 11,wherein said CNS disease is selected from the group comprisingHuntington's disease, Parkinson's disease, multiple sclerosis atrophy,Lewis body dementia (LBD), progressive supranuclear palsy,frontotemporal dementia and Angelman syndrome.
 13. The modified AAVvector for use according to any one of claims 10 to 12, wherein saidtransgene is under control of a CAG promoter.
 14. A method fortransducing a cell in the central nervous system (CNS) of a subject,comprising administering a modified adeno-associated virus (AAV) vectorto said subject, wherein said modified AAV vector comprises at least onesurface-bound saccharide, wherein said modified AAV vector isadministered directly to the CNS, and wherein said modified AAV vectoris not administered intracerebroventricularly.
 15. A modifiedadeno-associated virus (AAV) vector comprising at least one transgene,wherein said modified AAV comprises at least one surface-boundsaccharide, and wherein said transgene comprises a cDNA, or a fragmentthereof, from a gene selected from the group comprising 3R tau, 4R tau,AARS, ABCD1, ACOX1, ADGRV1, ADRA2B, AGA, AGER, ALDH7A1, ALG13, ALS2,ANG, ANXA11, APP, ARHGEF9, ARSA, ARSB, ARV1, ASAH1, ASPA, ATN1, ATP10A,ATP13A2, ATXN1, ATXN2, ATXN3, BAX, BCL-2, BDNF, BICD2, C9orf72, CACNA1A,CACNA1H, CACNB4, CASR, CCNF, CDKL5, CERS1, CFAP410, CHCHD10, CHD2,CHMP2B, CHRNA2, CHRNA4, CHRNA7, CHRNB2, CLCN2a, CLN1, CLN2, CLN3, CLN5,CLN6, CLN8, CNTN2, CPA6, CSTB, CTNS, CTSA, CTSD, DAO, DCTN1, DEPDC5,DMD, DNAJB2, DNM1, DOCK7, DRD2, DYNC1H1, EEF1A2, EFHC1, EGLN1, EPHA4,EPM2A, ERBB4, FGF12, FIG4, FRRS1L, FTL, FUCA1, FUS, FXN, GAA, GABRA1,GABRB1, GABRB3, GABRD, GABRG2, GAL, GALC, GALNS, GBA, GFAP, GLA, GLB1,GLE1, GLT8D1, GNAO1, GNS, GOSR2, GPR98, GRIA1, GRIA2, GRIK1, GRIM,GRIN2A, GRIN2B, GRIN2D, GSTM1, GUF1, GUSB, HCN1, HGSNAT, HNRNPA1, HTT,HYAL1, IDS, IDUA, IGHMBP2, IL-1, IT15, ITPA, JPH3, KCNA2, KCNB1, KCNC1,KCNMA1, KCNA2, KCNQ3, KCNT1, KCTD7, LAL, LAMP2, LGI1, LMNB2, LRRK2,MAN2B1, MAN2B2, MAN2C1, MANBA, MATR3, MBD5, MFSD8, NAGA, NAGLU, NECAP1,NEFH, NEK1, NEU1, NHLRC1, NPC1, NPC2, NR4A2, NTRK2, OCA2, OPTN, PARK2,PARK7, PCDH19, PEX1, PEX2, PEX3, PEX5, PEX6, PEX10, PEX11B, PEX12,PEX13, PEX14, PEX16, PEX19, PEX26, PFN1, PINK1, PLCB1, PNPO, PON1, PON2,PON3, PPARGC1A, PRDM8, PRICKLE1, PRKN, PRNP, PRPH, PRRT2, PSAP, S106β,SCARB2, SCN1A, SCN1B, SCN2A, SCN8A, SCN9A, SCN9Ab, SETX, SGSH, SIGMAR1,SIK1, SKP1, SLC1A1, SLC1A2, SLC2A1, SLC6A1, SLC9A6, SLC12A5, SLC13A5,SLC25A12, SLC25A22, SLCA17A5, SMN1, SMPD1, SNCA, SNRPN, SOD1, SPG11,SPTAN1, SQSTM1, ST3GAL3, ST3GAL5, STX1B, STXBP1, SYP, SYT1, SZT2, TAF15,TARDBP, TBC1D24, TBCE, TBK1, TBP, TITF-1, TREM2, UBA5, UBE1, UBE3A,UBQLN2, UCH-L1, UNC13A, VAPB, VCP, VPS35, WWOX, and XBP1; preferablyunder control of a promoter.
 16. A kit or kit-of-parts suitable for:transducing a cell in the central nervous system (CNS) of a subject;and/or delivering a transgene to the central nervous system (CNS) of asubject; and/or preventing and/or treating a central nervous system(CNS) disease in a subject, said kit comprising: (a) the modified AAVvector according to claim 15, (b) a device for CNS delivery of themodified AAV vectors, and (c) optionally, instructions for CNS deliveryof the modified AAV vector.
 17. A method of treating a CNS disease, themethod comprising a step of: administering directly to a CNS site, otherthan by intracerebroventricular injection, an AAV vector that is amodified AAV vector in that it contains at least one surface-conjugatedsaccharide.
 18. In a method of administering an AAV vector to the CNS,the improvement that comprises: administering an AAV vector that is amodified AAV vector in that it contains at least one surface-conjugatedsaccharide; and administering the modified AAV vector other than byintracerebroventricular injection.
 19. In a method of delivering atransgene to the CNS, the improvement that comprises: including thetransgene in an AAV vector that is a modified AAV vector in that itcontains at least one surface-conjugated saccharide; and administeringthe modified AAV vector other than by intracerebroventricular injection.20. The improvement of claim 18 or claim 19, wherein the step ofadministering comprises directly administering to a CNS site.
 21. Themethod of claim 17 or the improvement of claim 20, wherein the step ofadministering comprises injecting into the CNS site.
 22. The method orimprovement of claim 21, wherein the step of administering comprisesadministering directly to only one CNS site.
 23. The method orimprovement of claim 21 or 22, wherein the step of administeringcomprises administering by a single injection.
 24. The method of claim17 or the improvement of claim 18 or claim 19, wherein the saccharide isconjugated to the surface via a linker.
 25. The method or improvement ofany one of claims 17-24, wherein the step of administering comprisesadministering to a human subject.
 26. The method or improvement of anyone of claims 17-25, wherein the step of administering comprisesadministering to a subject suffering from a CNS disease selected from aCNS infectious disease, a CNS degenerative disease, a CNS auto-immunedisease, a CNS tumor disease, a cerebrovascular disease, a CNS injury, aCNS structural defect, and combinations thereof.
 27. The method orimprovement of any one of claims 17-26, wherein the step ofadministering comprises administering to a subject suffering from a CNSdisease selected from the group comprising acid lipase disease, acidmaltase deficiency, acid storage disease, acquired epileptiform aphasia,acute disseminated encephalomyelitis, attention deficit hyperactivitydisorder (ADHD), Adie's pupil, Adie's syndrome, adrenoleukodystrophy,agnosia, Aicardi syndrome, Aicardi-Goutieres syndrome disorder,Alexander disease, Alpers' disease, alternating hemiplegia, Alzheimer'sdisease, amyotrophic lateral sclerosis (ALS), anencephaly, aneurysm,Angelman syndrome, angiomatosis, anoxia, antiphospholipid syndrome,aphasia, apraxia, arachnoiditis, Arnold-Chiari malformation, aromaticL-amino acid decarboxylase deficiency (AADC deficiency),aspartylglucosaminuria, Asperger syndrome, ataxia, ataxia telangiectasia(Louis-Bar syndrome), ataxias and cerebellar or spinocerebellardegeneration, attention deficit-hyperactivity disorder, autism,autonomic dysfunction, Barth syndrome, Batten disease, Becker'smyotonia, Behcet's disease, Bell's palsy, Bernhardt-Roth syndrome,Binswanger's disease, Bloch-Sulzberger syndrome, Bradbury-Egglestonsyndrome, Brown-Sequard syndrome, bulbospinal muscular atrophy, CADASIL,Canavan's disease, causalgia, cavernomas, cavernous angioma, centralcervical cord syndrome, central cord syndrome, central pontinemyelinolysis, ceramidase deficiency, cerebellar degeneration, cerebellarhypoplasia, cerebral beriberi, cerebral gigantism, cerebral palsy,cerebro-oculo-facio-skeletal syndrome (COFS), cholesterol ester storagedisease, chorea, choreoacanthocytosis, chronic inflammatorydemyelinating polyneuropathy (CIDP), chronic orthostatic intolerance,chronic pain, Cockayne syndrome type II, Coffin-Lowry syndrome,colpocephaly, congenital myasthenia, corticobasal degeneration, cranialarteritis, cree encephalitis, Creutzfeldt-Jakob disease, Cushing'ssyndrome, cystinosis, cytomegalic inclusion body disease, dancingeyes-dancing feet syndrome, Dandy-Walker syndrome, Danon disease, Dawsondisease, De Morsier's syndrome, Dejerine-Klumpke palsy, dementia,dentate cerebellar ataxia, dentatorubral atrophy, dermatomyositis,developmental dyspraxia, Devic's syndrome, diffuse sclerosis,dysautonomia, dysgraphia, dyslexia, dysphagia, dyspraxia, dyssynergiacerebellaris myoclonica, dyssynergia cerebellaris progressiva, epilepsy(including Amish infantile epilepsy syndrome [AIES], benign familialinfantile seizures [BFIS], benign familial neonatal seizures [BFNS],childhood absence epilepsy [CAE], childhood-onset epilepticencephalopathy [COEE], Dravet syndrome [DS], early infantile epilepticencephalopathy [EIEE], familial adult myoclonic epilepsy [FAME],familial febrile seizures [FFS], familial focal epilepsy with variablefoci [FFEVF], familial infantile myoclonic epilepsy [FIME], familialtemporal lobe epilepsy [FTLE], focal epilepsy and speech disorder [FESD]with or without mental retardation, generalized epilepsy and paroxysmaldyskinesia [GEPD], generalized epilepsy with febrile seizures plus[GEFS+], idiopathic generalized epilepsy [IGE], juvenile absenceepilepsy [JAE], juvenile myoclonic epilepsy [JME], myoclonic-atonicepilepsy [MAE], nocturnal frontal lobe epilepsy [NFLE], progressivemyoclonic epilepsy [PME], pyridoxamine 5′-phosphate oxidase deficiency[PNPOD], pyridoxine-dependent epilepsy [EPD] and severe myoclonicepilepsy of infancy [SMEI]), Fabry disease, Fahr's syndrome, familialdysautonomia, familial hemangioma, familial idiopathic basal gangliacalcification, familial periodic paralyses, familial spastic paralysis,Farber's disease, fibromuscular dysplasia, Fisher syndrome, floppyinfant syndrome, Friedreich's ataxia, frontotemporal dementia,fucosidosis, galactosialidosis, Gaucher disease, generalizedgangliosidosis, Gerstmann's syndrome, Gerstmann-Straussler-Scheinkerdisease, giant axonal neuropathy, giant cell arteritis, giant cellinclusion disease, globoid cell leukodystrophy, glossopharyngealneuralgia, glycogen storage disease, GM1 gangliosidosis, GM2gangliosidosis (Tay-Sachs disease), Guillain-Barre syndrome,Hallervorden-Spatz disease, hemicrania continua, hemiplegia alterans,hereditary spastic paraplegia, heredopathia atactica polyneuritiformis,Holmes-Adie syndrome, holoprosencephaly, Hughes syndrome, Huntington'sdisease, hydranencephaly, hydromyelia, hypercortisolism, immune-mediatedencephalomyelitis, inclusion body myositis, incontinentia pigmenti,infantile hypotonia, infantile neuroaxonal dystrophy, iniencephaly,Isaac's syndrome, Joubert syndrome, Keams-Sayre syndrome, Kennedy'sdisease, Kinsbourne syndrome, Kleine-Levin syndrome, Klippel-Feilsyndrome, Klippel-Trenaunay syndrome (KTS), Kliiver-Bucy syndrome,Korsakoff s amnesic syndrome, Krabbe disease, Kugelberg-Welanderdisease, Lambert-Eaton myasthenic syndrome, Landau-Kleffner syndrome,lateral femoral cutaneous nerve entrapment, lateral medullary syndrome,Leigh's disease, Lennox-Gastaut syndrome, Lesch-Nyhan syndrome,Levine-Critchley syndrome, Lewy body dementia, lipoid proteinosis,lissencephaly, locked-in syndrome, Lou Gehrig's disease, lupus, Lymedisease, Machado-Joseph disease, macrencephaly, alpha-mannosidosis,beta-mannosidosis, Melkersson-Rosenthal syndrome, Menkes disease,meralgia paresthetica, metachromatic leukodystrophy, microcephaly,Miller Fisher syndrome, Moebius syndrome, mucopolysaccharidosis type I-H(Hurler syndrome), mucopolysaccharidosis type I-H/S (Hurler-Scheiesyndrome), mucopolysaccharidosis type IS (Scheie syndrome),mucopolysaccharidosis type II (Hunter syndrome), mucopolysaccharidosistype III-A (Sanfilippo syndrome A), mucopolysaccharidosis type III-B(Sanfilippo syndrome B), mucopolysaccharidosis type III-C(Sanfilipposyndrome C), mucopolysaccharidosis type III-D (Sanfilippo syndrome D),mucopolysaccharidosis type IV-B (Morquio syndrome B),mucopolysaccharidosis type VI (Maroteaux-Lamy syndrome),mucopolysaccharidosis type VII (Sly syndrome), mucopolysaccharidosistype IX (Natowicz syndrome), multiple sclerosis, muscular dystrophy,myasthenia gravis, myelinoclastic diffuse sclerosis, narcolepsy,neuroacanthocytosis, neurofibromatosis, neuroleptic malignant syndrome,neurosarcoidosis, Niemann-Pick disease, Ohtahara syndrome,olivopontocerebellar atrophy, opsoclonus myoclonus, O'Sullivan-McLeodsyndrome, pantothenate kinase-associated neurodegeneration,paraneoplastic syndromes, paresthesia, Parkinson's disease, paroxysmalchoreoathetosis, paroxysmal hemicrania, Parry-Romberg syndrome,Pelizaeus-Merzbacher disease, Pena Shokeir II syndrome, periventricularleukomalacia, phytanic acid storage disease, Pick's disease, piriformissyndrome, polymyositis, Pompe disease, post-polio syndrome, posteriorcortical atrophy, primary dentatum atrophy, primary lateral sclerosis,primary progressive aphasia, prion diseases, progressive hemifacialatrophy, progressive locomotor ataxia, progressive multifocalleukoencephalopathy, progressive sclerosing poliodystrophy, progressivesupranuclear palsy, prosopagnosia, Ramsay Hunt syndrome I, Ramsay Huntsyndrome II, Rasmussen's encephalitis, Refsum disease, Rett syndrome,Reye's syndrome, Riley-Day syndrome, Sandhoff disease, Schilder'sdisease, Seitelberger disease, Shy-Drager syndrome, Sjogren's syndrome,spasticity, spina bifida, spinal muscular atrophy, spinocerebellarataxia, spinocerebellar atrophy, spinocerebellar degeneration,Steele-Richardson-Olszewski syndrome, striatonigral degeneration,Sturge-Weber syndrome, tardive dyskinesia, tauopathy, Tay-Sachs disease,thoracic outlet syndrome, thyrotoxic myopathy, tic douloureux, Todd'sparalysis, trigeminal neuralgia, tropical spastic paraparesis, Troyersyndrome, vascular dementia, Von Economo's disease, Von Hippel-Lindaudisease (VHL), Von Recklinghausen's disease, Wallenberg's syndrome,Werdnig-Hoffman disease, Wernicke-Korsakoff syndrome, West syndrome,Whipple's disease, Williams syndrome, Wilson disease, Wolman's disease,X-linked spinal and bulbar muscular atrophy, and Zellweger syndrome. 28.The method or improvement of any one of claims 17-26, wherein the AAVcomprises a transgene.
 29. The method or improvement of claim 28,wherein the transgene comprises a cDNA, or a fragment thereof, from agene selected from the group comprising 3R tau, 4R tau, AARS, ABCD1,ACOX1, ADGRV1, ADRA2B, AGA, AGER, ALDH7A1, ALG13, ALS2, ANG, ANXA11,APP, ARHGEF9, ARSA, ARSB, ARV1, ASAH1, ASPA, ATN1, ATP10A, ATP13A2,ATXN1, ATXN2, ATXN3, BAX, BCL-2, BDNF, BICD2, C9orf72, CACNA1A, CACNA1H,CACNB4, CASR, CCNF, CDKL5, CERS1, CFAP410, CHCHD10, CHD2, CHMP2B,CHRNA2, CHRNA4, CHRNA7, CHRNB2, CLCN2a, CLN1, CLN2, CLN3, CLN5, CLN6,CLN8, CNTN2, CPA6, CSTB, CTNS, CTSA, CTSD, DAO, DCTN1, DEPDC5, DMD,DNAJB2, DNM1, DOCK7, DRD2, DYNC1H1, EEF1A2, EFHC1, EGLN1, EPHA4, EPM2A,ERBB4, FGF12, FIG4, FRRS1L, FTL, FUCA1, FUS, FXN, GAA, GABRA1, GABRB1,GABRB3, GABRD, GABRG2, GAL, GALC, GALNS, GBA, GFAP, GLA, GLB1, GLE1,GLT8D1, GNAO1, GNS, GOSR2, GPR98, GRIA1, GRIA2, GRIK1, GRIN1, GRIN2A,GRIN2B, GRIN2D, GSTM1, GUF1, GUSB, HCN1, HGSNAT, HNRNPA1, HTT, HYAL1,IDS, IDUA, IGHMBP2, IL-1, IT15, ITPA, JPH3, KCNA2, KCNB1, KCNC1, KCNMA1,KCNQ2, KCNQ3, KCNT1, KCTD7, LAL, LAMP2, LGI1, LMNB2, LRRK2, MAN2B1,MAN2B2, MAN2C1, MANBA, MATR3, MBD5, MFSD8, NAGA, NAGLU, NECAP1, NEFH,NEK1, NEU1, NHLRC1, NPC1, NPC2, NR4A2, NTRK2, OCA2, OPTN, PARK2, PARK7,PCDH19, PEX1, PEX2, PEX3, PEX5, PEX6, PEX10, PEX11B, PEX12, PEX13,PEX14, PEX16, PEX19, PEX26, PFN1, PINK1,PLCB1, PNPO, PON1, PON2, PON3,PPARGC1A, PRDM8, PRICKLE1, PRKN, PRNP, PRPH, PRRT2, PSAP, S106β, SCARB2,SCN1A, SCN1B, SCN2A, SCN8A, SCN9A, SCN9Ab, SETX, SGSH, SIGMAR1, SIK1,SKP1, SLC1A1, SLC1A2, SLC2A1, SLC6A1, SLC9A6, SLC12A5, SLC13A5,SLC25A12, SLC25A22, SLCA17A5, SMN1, SMPD1, SNCA, SNRPN, SOD1, SPG11,SPTAN1, SQSTM1, ST3GAL3, ST3GAL5, STX1B, STXBP1, SYP, SYT1, SZT2, TAF15,TARDBP, TBC1D24, TBCE, TBK1, TBP, TITF-1, TREM2, UBA5, UBE1, UBE3A,UBQLN2, UCH-L1, UNC13A, VAPB, VCP, VPS35, WWOX, and XBP1.
 30. The methodor improvement of any one of claim 17 or 20-29, wherein the CNS site isthe striatum.
 31. The method or improvement of any one of claim 17 or20-29, wherein the CNS site is the thalamus.
 32. The method orimprovement of any one of claim 17 or 20-29, wherein the CNS site is thecisterna magna.
 33. The method or improvement of any one of claim 17 or20-29, wherein the CNS site is the striatum. the thalamus. the cisternamagna, or a combination thereof.